title: Validation of a histologic scoring system for the examination of quality of tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To develop and validate a histologic scoring system for the assessment of tendon graft to bone tunnel healing in anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  The scoring system, tendon-bone tunnel healing (TBTH) score, comprised 5 items on graft status,fiber type and interface connectivity, evaluated on either a 5- or 6-point scale. Two observers were trained to use the scoring system, examining 15 blinded histologic slides from an ongoing study. Afterward, an independent validation dataset consisting of 89 blinded histologic slides from the same study of different time points, tunnel positions and bone tunnels were scored for validity and reliability. Interrater and intrarater reliabilities were calculated. The sum was validated by the time-dependent change of healing.
  
  
  RESULTS
  Both the intrarater and interrater reliabilities of the scoring system were high, with weighted K of 0.90-0.99 (all p < 0.001) and 0.84-0.94 (all p < 0.001), respectively, for different items. The sum of score increased significantly with time at different segments of both tunnels (all p < 0.05), consistent with the process of tunnel healing.
  
  
  CONCLUSIONS
  TBTH score is a reliable, valid measure for evaluating the histologic outcome of tendon graft to bone tunnel healing in ACL reconstruction.
authors: Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. pauline@ort.cuhk.edu.hk
authors: Pauline Po Yee
authors: PP
authors: Lui
authors: Grace
authors: G
authors: Ho
authors: Yuk Wa
authors: YW
authors: Lee
authors: Po Yan
authors: PY
authors: Ho
authors: Wing Nin
authors: WN
authors: Lo
authors: Chun Kwong
authors: CK
authors: Lo
mesh_terms: D000818:Animals; D059549:Anterior Cruciate Ligament Reconstruction; D001842:Bone and Bones / Q000473:pathology; D005260:Female; D006652:Histological Techniques; D011786:Quality Control; D011817:Rabbits; D012107:Research Design; D013708:Tendon Injuries / Q000473:pathology / Q000628:therapy*; D013710:Tendons / Q000473:pathology* / Q000637:transplantation*; D019737:Transplants; D014945:Wound Healing