Can Conventional X Ray Imaging Predict for Anterior Cruciate Ligament Reconstruction Failure

Transcription

1 Can Cnventinal X Ray Imaging Predict fr Anterir Cruciate Ligament Recnstructin Failure 12 th Biennial ISAKOS Cngress Cancun, Mexic th May 2019 Adham Elgeidi, M.D. Mhammed Badran, M.D. Mansura Schl f Medicine, Mansura, EGYPT

2 N Cnflict f interest Adham Elgeidi, MD I have n financial cnflicts t disclse Mhammed Badran, MD I have n financial cnflicts t disclse

3 Aim f wrk Crrelate between radilgical parameters & clinical results f ACLR, & Cmpare between cnventinal X Ray & CT scans as tls f assessment. Study hypthesis Gd X Ray parameters wuld indicate gd clinical results, whilst Imprper X Ray parameters means unsatisfactry clinical results.

4 Patients and Methds Retrspective study evaluate radilgical & clinical results f Islated single bundle trans-antermedial prtal ACLR using quadruple Hamstring graft Fixed with interference screws n bth sides with > 2 years fllw up: - Knee Surgery Unit, Mansura University Hspitals, Mansura, EGYPT - Over 4 years frm January 2012 till December 2015.

5 A- Radilgical Assessment: Methds 1. Plain X Rays (AP & Lateral views) 2. Cmputed Tmgraphy (CT). Patient was cnsidered t have: Anatmical ACLR: bth tunnels anatmical, Nn-anatmical ACLR: B- Clinical Assessment: ne r bth tunnels nt anatmical. Orthpedic fellw wh was blind t radilgical results assessed all patients clinically: 1. IKDC scre 2. Lyshhm scre.

6 (Khalfayan EE et al., 1996 AJSM, Pinczewski L et al., 2008 JBJS Am, Lee JK et al., 2015 KSSTA) X Ray Tunnel psitin: 1. Tibial tunnel : ~ Lat View: 38-42% tibial plateau frm anterir ~ AP view: 47-52% tibial plateau frm medial 2. Femral tunnel : ~ Lat View: 86% f AP length f Blumensaat s & ~ AP view: 43% distance frm lateral crtex.

7 CT Tunnel psitin: 3D CT (Bernard Grid Methd): Anatmical femral tunnel center 20-25% depth 15-20% height. Anatmical tibial tunnel center 38-42% AP 47-52% ML. #### 100% 0% 100% D 0% H femral ftprint depth 0% very psterir t 100% very anterir height 0 % very prximal t 100% very distal (Lee JK et al., 2015 KSSTA, Xu H et al., 2016 Arthrscpy)

8 Results Our database 200 ACLR dne during study perid. Out f these, 70 patients hamstring tendn graft / interference screws / > 2 years fllw up. 7 patients refused t participate & 3 patients culdn t be reached 60 patients included in this study.

9 Crrelating bjective IKDC scre & CT data: Pstperative Radilgical data (CT) A (n=11) B (n=34) C (n=12) D (n=3) p-value Femral_3D_sagital_ view N % N % N % N % Anatmical Nn anatmical ** Tibia_frm ant. T pst. Anatmical ** Nn anatmical Tibia_medilat Anatmical Nn anatmical Widening Femral tunnel by traditinal methd Median (Min-Max) 2 (1-4) 3 (.0-4) 2 (0-7) 4 (3-6) Widening Tibial tunnel by traditinal methd Median (Min-Max) 2 (.0-3) 2 (-1-4) 2 (.0-4) 3 (1-4) Narrwing Femral tunnel at rifice -2(- 4:-1) (- 5:0) 1 (-2.5:2) ab 2( 2-9) abc.001** Narrwing Tibial tuunel at rifice -3(- 5:-1) -2.5 (- 5:1) 1(- 3:1) ab 1( 1-6) ab.001** fem. Tunnel angle crnal 33.45± ±3.08 a 38.33±3.98 ab 41.67±7.23 ab F= p=0.001* tibial tunnel angle crnal 55.00± ± ± ±8.50 F= p= tibial tunnel angle sagittal 52.45± ±2.86 a 51.67± ±11.59 abc F= p=0.002* Graft crnal angle in degree 68.77± ± ± ±5.29 abc 0.016* Graft sagittal angle In degree 48.82± ± ± ±

10 Crrelating CT tunnel psitin with ther CT data: (CT) AA (n=46) NN (n=9) AN (n=2) NA (n=3) Test f sig. p- value Widening femral tunnel by traditinal methd 2.50 ( ) 1.00 ( ) 3.00 ( ) 1.00 ( ) KW=4.49 p=0.213 Widening tibial tunnel by traditinal methd 2.00 ( ) ( ) 3.00 ( ) 1.00 ( ) KW=7.15 p=0.067 Narrwing femral tunnel at rifice ( ) 0.0 ( ) a 1.00 ( ) a 1.00 ( ) a KW=23.57 p=<.001** Narrwing tibial tunnel at rifice ( ) 1.00 ( ) a 1.00 ( ) a 1.00 ( ) a KW= p=<.001** fem. Tunnel crnal angle 35.82± ± ± ±4.04 F=1.16 p=0.330 tibial tunnel crnal angle 53.50± ± ± ±7.00 F=2.45 p=0.072 tibial tunnel sagittal angle 50.56± ± ± ±5.13 F= p=0.618 graft crnal angle in degree 68.77± ± ± ±5.29 abc F= 7.68 p=<0.001** graft sagittal angle In degree 49.32± ±4.9 a 44.00±1.41 a 50.66±7.50 bc F=6.67 p=0.001*

11 Discussin Many f radilgical parameters ly crrelated t clinical utcme: 1. Anatmical tunnel psitin, 2. Orifice narrwing, 3. Tunnel inclinatin angle, 4. Graft inclinatin angle: ~ angle near hrizntal plane better clinical utcme, ~ graft inclinatin angle resembled native ACL (68.77 ± 2.93 crnal & ± 1.94 sagittal) satisfactry N statistically difference between CT & cnventinal X ray fr assessment f ACLR tunnel psitin & widening. Nevertheless, nt all cases culd be assessed by X ray especially femral tunnel & tunnel rifice. Cases fully assessed by X ray (21 ut f 60 = 35%).

12 Cnclusin Satisfactry clinical utcme crrelates with prper radilgical measures f ACLR. Cnventinal X Rays can help identify ACLR failure: ~ cnstitutes a cheaper ptin than CT & ~ mre imprtantly less radiatin expsure. If X ray is nt clear & accurate (65%) d CT scan. We recmmend add radilgical parameters as part f pst-perative ACLR scrning system.

13 References Khalfayan EE, Sharkey PF, Alexander AH et al., (1996) The Relatinship Between Tunnel Placement and Clinical Results After Anterir Cruciate Ligament Recnstructin. AJSM ; 24(3): Pinczewski L, Salmn L, Jacksn W et al., (2008) Radilgical Landmarks fr Placement f the Tunnels in Single-bundle Recnstructin f the Anterir Cruciate Ligament. Bne & Jint Jurnal; 90(2): Lee JK, Lee S, Seng SC, Lee MC (2015) Anatmy f the Anterir Cruciate Ligament Insertin Sites: Cmparisn f Plain Radigraphy and Threedimensinal Cmputed Tmgraphic Imaging t Anatmic Dissectin. KSSTA; 23 (8): Xu H, Zhang C, Zhang Q et al., (2016) A systematic Review f Anterir Cruciate Ligament Femral Ftprint Lcatin Evaluated by Quadrant Methd fr Single-bundle and Duble-bundle Anatmic Recnstructin. Arthrscpy; 32 (8):