title: Reliability of 3-Dimensional Computed Tomography for Application of the Bernard Quadrant Method in Femoral Tunnel Position Evaluation After Anatomic Anterior Cruciate Ligament Reconstruction.
abstract: To validate whether the Bernard quadrant method, which was developed for application on simple lateral radiography, can be used with 3-dimensional computed tomography (3D CT) to localize the femoral insertion of the reconstructed anterior cruciate ligament (ACL).
  
  
  
  We analyzed 32 knees with ACL tears that were reconstructed using a metal interference screw for fixation at the femoral tunnel between March 2012 and May 2013. Postoperative lateral radiographs and 3D CT images were obtained 7 days after the operation. By use of the Bernard quadrant method, the location of the femoral tunnel was measured by 2 orthopaedic surgeons by locating the position of the metal interference screw using 3D CT imaging and simple lateral knee radiography. The correlation between the femoral tunnels on the 2 radiographic images was compared using the MedCalc statistical analysis program.
  
  
  
  On the 3D CT image, the position of the femoral insertion of the ACL as measured by the position of the metal screw head was 36.3% ± 6.0% in the x-coordinate and 39.6% ± 9.1% in the y-coordinate compared with 37.6% ± 5.8% and 41.0% ± 11.6%, respectively, on the simple radiograph. The Pearson correlation coefficients between 3D CT and simple radiography were 0.840 for the x-coordinate and 0.858 for the y-coordinate. Intraobserver reliability and interobserver reliability for both coordinates were greater than 0.9 on 3D CT.
  
  
  
  Application of the Bernard quadrant method on 3D CT showed high correlation to the originally described method using lateral radiographs and can be used reliably for localizing the reconstructed ACL.
  
  
  
  Level III, diagnostic study.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Dong Hwi
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Won-Bong
authors.initials: WB
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Cho
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
authors.forename: Chae-Won
authors.initials: CW
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea. Electronic address: Suenghwan.jo@gmail.com.
authors.forename: Suenghwan
authors.initials: S
authors.lastname: Jo
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001863:Bone Screws; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011184:Postoperative Period; D011859:Radiography; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult