Measurement of Medial Tibial Eminence Dimensions for the Clinical Evaluation of ACL-Injured Knees: A Comparison between CT and MRI

2021 ◽  
Author(s):  
Hayk Stepanyan ◽  
Jaron Nazaroff ◽  
Ngoc Le ◽  
Robert Parker ◽  
Toshimi Tando ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Acl Injuries ◽  
Intraarticular Fracture ◽  
Tibial Eminence ◽  
Picture Archiving And Communication ◽  
Width Measurements ◽  
Mri Measurements ◽  
Ct And Mri

AbstractAnterior cruciate ligament (ACL) injuries commonly lead to translational and rotational tibiofemoral instability. The morphology of the medial tibial eminence (MTE) has received increased attention regarding its role in tibiofemoral stability in ACL-injured knees. Therefore, quantification of MTE dimensions on clinical imaging may help clinicians predict knee stability after ACL injury. Although magnetic resonance imaging (MRI) is routinely obtained in patients with ACL injuries, whether the dimensions of the MTE can be accurate quantified on MRI is unknown. The purpose of this study was to assess the degree of correlation between measurements of MTE height and width on computed tomography (CT) versus MRI. An institutional picture archiving and communication system imaging database was used to identify patients aged between 15 and 60 years who received concurrent MRI and CT of the same knee within a 1-year interval. Knees with significant arthrosis, deformity, intraarticular fracture, or hardware-related artifact that obscured visualization of the MTE were excluded. Mean differences and interstudy agreement between CT and MRI MTE measurements were compared using concordance correlation coefficient (r c) and Bland–Altman analysis. A total of 41 knees in 38 patients (mean age, 37 years; 82% male) were analyzed. Interrater reliability for CT and MRI measurements was high (intraclass correlation coefficient = 0.740–0.954). On coronal CT and MRI, mean MTE height measurements were 10.4 ± 1.9 and 10.4 ± 1.8 mm, respectively; mean MTE width measurements were 14.6 ± 3.6 and 14.2 ± 3.0 mm, respectively. On sagittal CT and MRI, mean MTE height measurements were 11.6 ± 1.7 and 11.7 ± 1.7 mm, respectively; mean MTE width measurements were 36.5 ± 4.8 and 36.2 ± 5.0 mm, respectively. Good agreement was observed between CT and MRI measurements of MTE height and width on coronal and sagittal planes (r c = 0.947–0.969). Measurements of MTE height and width were similar on MRI relative to CT on both coronal and sagittal planes. MRI may be suitable for characterizing the dimensions of the MTE when clinically evaluating patients with ACL injuries, potentially allowing for individualized patient care.

Inter-rater Variability Interferes with Reproducibility of Splenic Injury Grades Reported to the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (2) ◽  
pp. 171-174
Author(s):  
Eric J. Ferguson ◽  
Michael Walsh ◽  
Megan Brown
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Trauma Center ◽  
Ordinal Data ◽  
Injury Severity ◽  
Splenic Injury ◽  
Intraclass Correlation ◽  
American College Of Surgeons ◽  
Level I ◽  
Picture Archiving And Communication

The objective of this study was to determine reproducibility of our splenic injury grading data, previously reported to the American College of Surgeons Committee on Trauma for our most recent site visit. The institutional registry of a Level I trauma center was queried to identify adult patients presenting with blunt splenic injury between January 1, 2013 and December 31, 2013. Original CT scans were scanned into the picture archiving and communication system and subsequently reviewed by four trauma surgeons and two radiologists for clinical impressions of splenic injury grade. Grades assigned by the clinician and the grade recorded in the registry were compared for inter-rater reliability using the intraclass correlation coefficient, as a means of assessing variance of ordinal data. The intraclass correlation coefficient in our model was 0.77, which indicates that 77 per cent of the observed variance was due to true variance and 23 per cent of the variance was due to error. Variability in grading may, in some cases, underestimate injury severity and compromise the clinician's expectation of clinical outcome, both in real-time, as well as during retrospective review processes such as those used during the trauma center reverification process.

scholarly journals Assessment of the anterolateral ligament of the knee by 1.5 T magnetic resonance imaging

2018 ◽  
Vol 46 (4) ◽  
pp. 1486-1495 ◽  
Author(s):  
Volkan Kızılgöz ◽  
Ali Kemal Sivrioğlu ◽  
Hasan Aydın ◽  
Türkhun Çetin ◽  
Gökhan Ragıp Ulusoy
Keyword(s):  
Magnetic Resonance ◽  
Standard Error ◽  
Interobserver Reliability ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Anterolateral Ligament ◽  
Mr Images ◽  
Acl Injuries ◽  
Mean Width ◽  
The Relationship

Objective This study was performed to evaluate the visibility of the knee’s anterolateral ligament (ALL) by magnetic resonance (MR) imaging when evaluating injuries of the ALL in relation to injuries of the anterior cruciate ligament (ACL). Methods Two reviewers retrospectively analyzed MR images for the visibility and dimensions of the ALL and the relationship between ALL and ACL injuries. The intraclass correlation coefficient (ICC) and kappa analysis were used to assess interobserver reliability. The chi-square test was used to assess the relationship between ALL and ACL injuries. Results The entire ALL was viewed on 82% of all MR images. The ICC for ALL visualization ranged from moderate to perfect between the two readers. There was almost perfect agreement between the reviewers when evaluating ALL dimensions. The mean length ± standard error, median thickness, and mean width ± standard error of the ALL were 36.5 ± 0.6 mm, 2.5 mm, and 8.2 ± 0.2 mm, respectively. A statistically significant relationship was observed between ALL and ACL injuries. Conclusion The ALL was visible on most MR images, allowing ALL injuries to be noted during routine MR image interpretation. Radiologists should note concomitant ACL and ALL injuries as part of their assessments.

MRI quantitation of abdominal skeletal muscle correlates with CT-based analysis: implications for sarcopenia measurement

2019 ◽  
Vol 44 (8) ◽  
pp. 814-819 ◽  
Author(s):  
Amir Ishaq Khan ◽  
David A. Reiter ◽  
Aarti Sekhar ◽  
Puneet Sharma ◽  
Nabile M. Safdar ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Correlation Coefficient ◽  
Strong Correlation ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Observer Variability ◽  
Pearson Correlation Coefficient ◽  
Mri Segmentation ◽  
Muscle Area ◽  
Ct And Mri

Sarcopenia is associated with poor outcomes in a variety of conditions, including malignancy. Abdominal skeletal muscle area (SMA) segmentation using computed tomography (CT) has been shown to be an accurate surrogate for identifying sarcopenia. While magnetic resonance imaging (MRI) segmentation of SMA has been validated in cadaver limbs, few studies have validated abdominal SMA segmentation using MRI at lumbar level mid-L3. Our objective was to assess the reproducibility and concordance of CT and MRI segmentation analyses of SMA at mid-L3. This retrospective analysis included a random sample of 10 patients with renal cell carcinoma (RCC) and CT abdomen/pelvis, used to assess intra-observer variability of SMA measurements using CT. An additional sample of 9 patients with RCC and both CT and T2-weighted (T2w) MRI abdomen/pelvis was used to assess intra-observer variability of SMA using MRI and concordance of SMA between MRI and CT. SMA was segmented using Slice-O-Matic. SMA reproducibility was assessed using intraclass correlation coefficient (ICC). SMA concordance was analyzed using Bland–Altman plot and Pearson correlation coefficient. The intra-observer variability of CT and MRI SMA at mid-L3 was low, with ICC of 0.998 and 0.985, respectively. Bland–Altman analysis revealed bias of 0.74% for T2w MRI over CT. The Pearson correlation coefficient was 0.997 (p < 0.0001), demonstrating strong correlation between CT and T2w MRI. Abdominal SMA at mid-L3 is reproducibly segmented for both CT and T2w MRI, with strong correlation between the 2 modalities. T2w MRI can be used interchangeably with CT for assessment of SMA and sarcopenia. This finding has important clinical implications.

scholarly journals Reliability of Knee Flexion–Extension Lyapunov Exponent in People With and Without Anterior Cruciate Ligament Deficiency

2020 ◽  
Vol 29 (2) ◽  
pp. 253-256
Author(s):  
Salman Nazary-Moghadam ◽  
Mahyar Salavati ◽  
Ali Esteki ◽  
Behnam Akhbari ◽  
Sohrab Keyhani ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lyapunov Exponent ◽  
Correlation Coefficient ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Intraclass Correlation ◽  
Healthy Individuals ◽  
Anterior Cruciate Ligament Deficiency ◽  
Flexion Extension ◽  
Anterior Cruciate

Objectives: The current study assessed the intrasession and intersession reliability of the knee flexion–extension Lyapunov exponent in patients with anterior cruciate ligament deficiency and healthy individuals. Study Design: University research laboratory. Methods: Kinematic data were collected in 14 patients with anterior cruciate ligament deficiency and 14 healthy individuals walked on a treadmill at a self-selected, low, and high speed, with and without cognitive load. The intraclass correlation coefficient, standard error of measurement, minimal metrically detectable change, and percentage of coefficient of variation were calculated to assess the reliability. Results: The knee flexion–extension Lyapunov exponent had high intrasession reliability, with intraclass correlation coefficients ranging from .83 to .98. In addition, the intersession intraclass correlation coefficient values of these measurements ranged from .35 to .85 regardless of group, gait speed, and dual tasking. In general, relative and absolute reliability were higher in the patients with anterior cruciate ligament deficiency than in the healthy individuals. Conclusions: Although knee flexion–extension Lyapunov exponent demonstrates good intrasession reliability, its low intersession reliability indicates that changes of these measurements between different days should be interpreted with caution.

Prevention of ACL Injuries

1997 ◽  
Vol 6 (2) ◽  
pp. 80-96 ◽  
Author(s):  
Steven H. Ryder ◽  
Robert J. Johnson ◽  
Bruce D. Beynnon ◽  
Carl F. Ettlinger
Keyword(s):  
At Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Shielding Effect ◽  
Ligament Injury ◽  
Acl Injuries ◽  
Notch Width ◽  
Width Measurements ◽  
Anterior Cruciate

Athletes are particularly at risk for anterior cruciate ligament injury, and there is some evidence that female athletes are more at risk than males. The conflicting principles of stability and mobility are at odds within the knee, setting the stage for potentially serious injuries. Some investigators suggest that the size of the intercondylar notch should be used to identify athletes at risk for ACL damage, but more research is required before clinical decisions can be based on notch width measurements. Athletic shoe modifications and artificial playing surfaces may influence the incidence of ACL injures. Functional knee braces appear to have beneficial strain shielding effect on the ACL for anterior directed loads and internal–external torques applied to the tibia, but this effect appears to decrease as the magnitude of these anterior directed loads and torques increases. Ski equipment is often pointed to as a contributing factor in ACL injuries, but there is no evidence that modifications in ski equipment will decrease ACL disruptions. An education program based on recognizing the events that lead to ACL injury in skiing may reduce knee injuries in the future.

scholarly journals Do Tibial Eminence Fractures and Anterior Cruciate Ligament Tears Have Similar Outcomes?

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881185 ◽  
Author(s):  
Heath P. Melugin ◽  
Vishal S. Desai ◽  
Christopher L. Camp ◽  
Todd A. Milbrandt ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Activity Levels ◽  
Acl Injuries ◽  
Injury Rates ◽  
Tibial Eminence ◽  
Anterior Laxity ◽  
Surgical Fixation ◽  
Anterior Cruciate

Background: Avulsion fractures involving the tibial eminence are considered equivalent in terms of the cause to anterior cruciate ligament (ACL) tears; however, there are limited data comparing the outcomes of adolescent patients undergoing surgical fixation of a tibial eminence fracture (TEF) with those undergoing ACL reconstruction. Purpose: To compare the clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent TEF fixation with patients with midsubstance ACL tears who required acute reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients with TEFs treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years 2001 and 2015. Data regarding the initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using a physical examination, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and the Tegner activity score. Results: Sixty patients with a mean follow-up of 57.7 months (range, 24-206 months) were included; 20 patients (11 male, 9 female; mean age, 11.9 years [range, 7-15 years]) who underwent surgical fixation for a TEF were matched to a group of 40 patients (23 male, 17 female; mean age, 12.5 years [range, 8-5 years]) who underwent reconstruction for ACL tears. The TEF group demonstrated significantly lower postoperative IKDC scores (TEF group, 94.0; ACL group, 97.2; P = .04) and Lysholm scores (TEF group, 92.4; ACL group, 96.9; P = .02). The TEF group returned to sport 119 days sooner ( P < .01), but there was no difference in postoperative Tegner scores (TEF group, 7.3; ACL group, 7.6; P = .16). The TEF group demonstrated increased postoperative anterior laxity ( P = .02) and a higher rate of postoperative arthrofibrosis ( P = .04). There was no difference in subsequent ACL injuries ( P = .41). Conclusion: Both groups demonstrated quality outcomes at a minimum 2-year follow-up. Patients with TEFs demonstrated lower mean clinical outcome scores compared with patients with ACL tears, but the differences were less than reported minimal clinically important difference values. Additionally, the TEF group experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in the rate of subsequent ACL injuries. The TEF group returned to sport sooner than the ACL group, but the postoperative activity levels were similar.

scholarly journals Reliability and Validity of an Innovative Device for ACL Testing: The Mobil-Aider™

2020 ◽  
Vol 29 (2) ◽  
pp. 257-261
Author(s):  
Dawn T. Gulick
Keyword(s):  
Cruciate Ligament ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
The United States ◽  
Current Data ◽  
Acl Injuries ◽  
New Device ◽  
Anterior Cruciate ◽  
Double Blinded

Background: Knee disorders prevalence is estimated at more than 50% in a lifetime. There are over 250,000 anterior cruciate ligament (ACL) injuries per year in the United States. There are over 175,000 ACL reconstructions annually. This study was a double-blinded design to establish the reliability and validity of a new orthopedic device to measure linear translation of the tibia on the femur (ACL testing). Methods: A Zeiss Smartzoom microscope was used as the gold standard to assess the ability of the Mobil-Aider™ to measure linear translation. Sixty blinded measures were taken with each of 6 different devices. Results: Both the intraclass correlation and the Pearson correlation were .986. The Cronbach alpha reliability analysis was 0.992. Independent 1-sample t tests were performed on the differences between the Mobil-Aider™ and Zeiss values, and were not found to be significant (P = .42); that is, they were the same. Bland–Altman plot and a linear regression revealed no propositional bias. Finally, with 360 measures over 6 devices, the power of this study was calculated to be 100%. Discussion: This data are the first step in establishing reliability and concurrent validity of a new device. As a result of the current data, the Mobil-Aider™ device is deemed a promising orthopedic tool for use in assessing the laxity of the ACL. Additional testing needs to be performed on both healthy and injured knees. Conclusions: There is potential for the Mobil-Aider™ to contribute to the assessment of ACL injuries, but additional human testing is needed.

scholarly journals Biomechanical Measurement of Rabbit Cornea by a Modified Scheimpflug Device

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Bo Zhang ◽  
Jianjun Gu ◽  
Xiaoxiao Zhang ◽  
Bin Yang ◽  
Zheng Wang ◽  
...  
Keyword(s):  
Bulk Modulus ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Anterior Segment ◽  
Intraobserver Reliability ◽  
Rabbit Cornea ◽  
Deformation Response ◽  
Biomechanical Measurements ◽  
Biomechanical Measurement

Purpose. To explore the probability and variation in biomechanical measurements of rabbit cornea by a modified Scheimpflug device.Methods. A modified Scheimpflug device was developed by imaging anterior segment of the model imitating the intact eye at various posterior pressures. The eight isolated rabbit corneas were mounted on the Barron artificial chamber and images of the anterior segment were taken at posterior pressures of 15, 30, 45, 60, and 75 mmHg by the device. The repeatability and reliability of the parameters including CCT, ACD, ACV, and CV were evaluated at each posterior pressure. All the variations of the parameters at the different posterior pressures were calculated.Results. All parameters showed good intraobserver reliability (Cronbach’s alpha; intraclass correlation coefficient,α, ICC > 0.96) and repeatability in the modified Scheimpflug device. With the increase of posterior pressures, the ratio of CCT decreased linearly and the bulk modulus gradually reduced to a platform. The increase of ACD was almost linear with the posterior pressures elevated.Conclusions. The modified Scheimpflug device was a valuable tool to investigate the biomechanics of the cornea. The posterior pressure 15–75 mmHg range produced small viscoelastic deformations and nearly linear pressure-deformation response in the rabbit cornea.

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