Low inter- and intraobserver variability allows for reliable tunnel measurement in ACL reconstruction using the quadrant method.
BACKGROUND
Correct anatomic tunnel positions are essential in anterior cruciate ligament (ACL) reconstruction. To establish recommendations for tunnel positioning based on anatomical findings and to compare tunnel positions with clinical results, different radiological measurement methods as the quadrant method exist. Comparing the data of different observers requires the validation of the reliability of measurement methods. The purpose of this study therefore was to determine the reliability of the quadrant method to measure tunnel positions in ACL reconstruction. The hypothesis was, that the quadrant method shows a low inter- and intraobserver variability.


METHODS
In a test/retest scenario 20 knee surgeons were asked to determine defined tunnel positions in five lateral radiographs applying the quadrant method. Rotation, angle deviation, height and depth of the quadrant as well as absolute and relative tunnel positions of each observation were measured along referenced scales. Mean sizes and angle deviations of the quadrants, tunnel positions and deviations between the test/retest positions were calculated as well as standard deviations and range.


RESULTS
Interobserver variability analyses, to plan as well as to determine tunnel positions in ACL reconstruction, showed a mean variability (SD) of <1 mm, with ranges of 2.5 mm for planning and 3.7 mm for determination of tunnel positions using the quadrant method. Intraobserver analysis showed mean variability with deviations of <1 mm and maximum standard deviations of 0.7 mm and ranges of up to 2.3 mm.


CONCLUSIONS
We confirmed the hypothesis that the quadrant method has a low inter- and intraobserver variability. Based on the presented validation data, the quadrant method can be recommended as reliable method to radiographically describe insertion areas of the ACL as well as to determine tunnel positions in ACL reconstruction intra and postoperatively.
Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany, sven.shafizadeh@me.com.
Sven
S
Shafizadeh
Maurice
M
Balke
Stefan
S
Kelz
Juergen
J
Hoeher
Marc
M
Banerjee
D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery*; D015588:Observer Variation; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed