title: Measurements of bone tunnel size in anterior cruciate ligament reconstruction: 2D versus 3D computed tomography model.
abstract: BACKGROUND
  Revision anterior cruciate ligament (ACL) reconstruction requires a precise evaluation of previous tunnel locations and diameters. Enlargement of the tunnels, despite not usually affecting primary reconstruction outcomes, plays an important role in revision ACL management. Three dimensional (3D) computed tomography (CT) models are reported to be the most accurate method for identifying the tunnel position and possible conflicts with a revision tunnel placement. However, the ability of 3D CT to measure the tunnel size is still not proven. The goal of this study was to evaluate the ability of measuring the size of the bone tunnels in ACL reconstructed knees with 3D CT compared to the traditional two dimensional (2D) CT method.
  
  
  METHODS
  Twenty-four patients had CT scans performed immediately following ACL reconstruction surgery. Their femoral tunnels size were measured by a standard 2D CT measurement and then compared with three novel 3D CT measuring methods: the best transverse section method, the best fit cylinder method and the wall thickness method. The drill size used during surgery was used as a control measure for the tunnel width. Intra-class correlation coefficients were obtained.
  
  
  RESULTS
  The intra-class correlation coefficient and respective 95% confidence interval range (ICC [95%CI]) for the three methods compared with the drill sizes were 0.899 [0.811-0.947] for the best transverse section method, 0.745 [0.553-0.862] for the best fit cylinder method, -0.004 [-0.081 to -0.12] for the wall thickness method and 0.922 [0.713-0.97] for the 2D CT method. The mean differences compared to the drill size were 0.02 mm for the best fit transverse section method, 0.01 mm for the best fit cylinder diameter method, 3.34 mm for the wall thickness method and 0.29 mm for the 2D CT method. The intra-rater agreement (ICC [95%CI]) was excellent for the best transverse section method 0.999 [0.998-0.999] and the 2D CT method 0.969 [0.941-0.984].
  
  
  CONCLUSIONS
  The 3D best transverse section method presented a high correlation to the drill sizes and high intra-rater agreement, and was the best method for ACL tunnel evaluation in a 3D CT based model.
authors.affiliation: Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, 81657, CO, USA. becral@yahoo.com.br.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Crespo
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway. cathrineaga@gmail.com.
authors.forename: Cathrine
authors.initials: C
authors.lastname: Aga
authors.affiliation: Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, 81657, CO, USA. kwilson@sprivail.org.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Wilson
authors.affiliation: Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, 81657, CO, USA. shanpom@umich.edu.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Pomeroy
authors.affiliation: Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, 81657, CO, USA. drlaprade@sprivail.org.|The Steadman Clinic, Vail, CO, USA. drlaprade@sprivail.org.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway. lars.engebretsen@medisin.uio.no.|Oslo Sports Trauma Research Center, Oslo, Norway. lars.engebretsen@medisin.uio.no.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, 81657, CO, USA. cwijdicks@sprivail.org.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
keywords: 3D CT model; Anterior cruciate ligament; Revision ACL; Tunnel enlargement