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Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the distribution of different sizes of the area of the tibial insertion site among the population and to evaluate whether preoperative MRI measurements correlate with intraoperative findings to enable preoperative planning of the required graft size to cover the tibial insertion site sufficiently. The hypothesis was that the area of the tibial insertion site varies among individuals and that there is good agreement between MRI and intraoperative measurements.

Methods

Intraoperative measurements of the tibial insertion site were taken on 117 patients. Three measurements were taken in each plane building a grid to cover the tibial insertion site as closely as possible. The mean of the three measurements in each plane was used for determination of the area. Two orthopaedic surgeons, who were blinded to the intraoperative measurements, took magnetic resonance imaging (MRI) measurements of the area of the tibial insertion site at two different time points.

Results

The intraoperative measured mean area was 123.8 ± 21.5 mm2. The mean area was 132.8 ± 15.7 mm2 (rater 1) and 136.7 ± 15.4 mm2 (rater 2) when determined using MRI. The size of the area was approximately normally distributed. Inter-rater (0.89; 95 % CI 0.84, 0.92; p < 0.001) and intrarater reliability (rater 1: 0.97; 95 % CI 0.95, 0.98; p < 0.001; rater 2: 0.95; 95 % CI 0.92, 0.96; p < 0.001) demonstrated excellent test–retest reliability. There was good agreement between MRI and intraoperative measurement of tibial insertion site area (ICCs rater 1: 0.80; 95 % CI 0.71, 0.87; p < 0.001; rater 2: 0.87; 95 % CI 0.81, 0.91; p < 0.001).

Conclusion

The tibial insertion site varies in size and shape. Preoperative determination of the area using MRI is repeatable and enables planning of graft choice and size to optimally cover the tibial insertion site.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA

    Daniel Guenther, Sebastian Irarrázaval, Marcio Albers, Cara Vernacchia, James J. Irrgang, Volker Musahl & Freddie H. Fu

  2. Trauma Department, Hannover Medical School (MHH), Hannover, Germany

    Daniel Guenther

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  1. Daniel Guenther
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  2. Sebastian Irarrázaval
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  3. Marcio Albers
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  4. Cara Vernacchia
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  5. James J. Irrgang
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  6. Volker Musahl
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  7. Freddie H. Fu
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Correspondence to Freddie H. Fu.

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Guenther, D., Irarrázaval, S., Albers, M. et al. Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size. Knee Surg Sports Traumatol Arthrosc 25, 1576–1582 (2017). https://doi.org/10.1007/s00167-016-4295-7

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  • DOI: https://doi.org/10.1007/s00167-016-4295-7

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