title: Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images.
abstract: OBJECTIVE
  Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement.
  
  
  METHODS
  50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stäubli, and the method of Benereau for the VR approach.
  
  
  RESULTS
  The tunnel was visualized in 50-82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49-0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia.
  
  
  CONCLUSIONS
  CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs.
authors: Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands. d.meuffels@erasmusmc.nl
authors: Duncan E
authors: DE
authors: Meuffels
authors: Jan-Willem
authors: JW
authors: Potters
authors: Anton H J
authors: AH
authors: Koning
authors: Charles H
authors: CH
authors: Brown
authors: Jan A N
authors: JA
authors: Verhaar
authors: Max
authors: M
authors: Reijman
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D055815:Young Adult