title: Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction.
  
  
  METHODS
  Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions.
  
  
  RESULTS
  Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements.
  
  
  CONCLUSIONS
  Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 2701 Prairie Meadow Dr, Iowa City, IA 52242, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Warme
authors.forename: Austin J
authors.initials: AJ
authors.lastname: Ramme
authors.forename: Michael C
authors.initials: MC
authors.lastname: Willey
authors.forename: Carla L
authors.initials: CL
authors.lastname: Britton
authors.forename: John H
authors.initials: JH
authors.lastname: Flint
authors.forename: Annunziato S
authors.initials: AS
authors.lastname: Amendola
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000592:standards; D001175:Arthrography; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D015588:Observer Variation; D011182:Postoperative Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D016896:Treatment Outcome