Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears
Purpose To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears. Methods In this case–con...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021-09, Vol.29 (9), p.2967-2975 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Vermeijden, Harmen D. Cerniglia, Brett Mintz, Douglas N. Rademakers, Maarten V. Kerkhoffs, Gino M. M. J. van der List, Jelle P. DiFelice, Gregory S. |
| description | Purpose
To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears.
Methods
In this case–control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements.
Results
Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55–0.98] and 0.91–0.97 (95% CI 0.78–0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of |
| doi_str_mv | 10.1007/s00167-020-06312-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2451854634</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2563941313</sourcerecordid><originalsourceid>FETCH-LOGICAL-c352t-7212f1c6c77a5461162df13f6fba11bad58326b31b8e86eb9d3a196b0a2f2a113</originalsourceid><addsrcrecordid>eNp9kUFP3DAQha2qldhS_gAnS71wCXjsxNkcES0UCYkLnK2JM9kaOQm1HXX590y7SJV64OTRzPfejPyEOAV1Dkq1F1kpsG2ltKqUNaCr_QexgdqYqjV1-1FsVFfrSqvGHonPOT8pxWXdbcTvbyEXjDLRNONcZKR5V35Kj7PsSU6EeU008DgG7OOLxHmQz9wJvmQuwoTphafPGJJcRu4se-5F5gqlsCTp0-oDFpIx7HAiXlEIU_4iPo0YM528vcfi8fr7w9WP6u7-5vbq8q7yptGlajXoEbz1bYtNbQGsHkYwox17BOhxaLZG295Av6Wtpb4bDEJne4V61EyYY3F28OXLfq2Ui5tC9hQjzrSs2em6gS07m5rRr_-hT8uaZr7O6caargYDhil9oHxack40urdfcKDcnyzcIQvHWbi_Wbg9i8xBlBmed5T-Wb-jegX0rI5K</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2563941313</pqid></control><display><type>article</type><title>Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears</title><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals - AutoHoldings</source><creator>Vermeijden, Harmen D. ; Cerniglia, Brett ; Mintz, Douglas N. ; Rademakers, Maarten V. ; Kerkhoffs, Gino M. M. J. ; van der List, Jelle P. ; DiFelice, Gregory S.</creator><creatorcontrib>Vermeijden, Harmen D. ; Cerniglia, Brett ; Mintz, Douglas N. ; Rademakers, Maarten V. ; Kerkhoffs, Gino M. M. J. ; van der List, Jelle P. ; DiFelice, Gregory S.</creatorcontrib><description>Purpose
To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears.
Methods
In this case–control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements.
Results
Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55–0.98] and 0.91–0.97 (95% CI 0.78–0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (
p
< 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s).
Conclusion
This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively.
Level of evidence
III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-020-06312-x</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Algorithms ; Anterior cruciate ligament ; Confidence intervals ; Image reconstruction ; Injuries ; Knee ; Ligaments ; Magnetic resonance imaging ; Mathematical analysis ; Medicine ; Medicine & Public Health ; Orthopedics ; Patients ; Reliability analysis ; Sports Medicine ; Surgery ; Tearing</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021-09, Vol.29 (9), p.2967-2975</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-7212f1c6c77a5461162df13f6fba11bad58326b31b8e86eb9d3a196b0a2f2a113</citedby><cites>FETCH-LOGICAL-c352t-7212f1c6c77a5461162df13f6fba11bad58326b31b8e86eb9d3a196b0a2f2a113</cites><orcidid>0000-0002-9559-757X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-020-06312-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-020-06312-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Vermeijden, Harmen D.</creatorcontrib><creatorcontrib>Cerniglia, Brett</creatorcontrib><creatorcontrib>Mintz, Douglas N.</creatorcontrib><creatorcontrib>Rademakers, Maarten V.</creatorcontrib><creatorcontrib>Kerkhoffs, Gino M. M. J.</creatorcontrib><creatorcontrib>van der List, Jelle P.</creatorcontrib><creatorcontrib>DiFelice, Gregory S.</creatorcontrib><title>Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears.
Methods
In this case–control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements.
Results
Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55–0.98] and 0.91–0.97 (95% CI 0.78–0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (
p
< 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s).
Conclusion
This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively.
Level of evidence
III.</description><subject>Algorithms</subject><subject>Anterior cruciate ligament</subject><subject>Confidence intervals</subject><subject>Image reconstruction</subject><subject>Injuries</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Magnetic resonance imaging</subject><subject>Mathematical analysis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Reliability analysis</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Tearing</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kUFP3DAQha2qldhS_gAnS71wCXjsxNkcES0UCYkLnK2JM9kaOQm1HXX590y7SJV64OTRzPfejPyEOAV1Dkq1F1kpsG2ltKqUNaCr_QexgdqYqjV1-1FsVFfrSqvGHonPOT8pxWXdbcTvbyEXjDLRNONcZKR5V35Kj7PsSU6EeU008DgG7OOLxHmQz9wJvmQuwoTphafPGJJcRu4se-5F5gqlsCTp0-oDFpIx7HAiXlEIU_4iPo0YM528vcfi8fr7w9WP6u7-5vbq8q7yptGlajXoEbz1bYtNbQGsHkYwox17BOhxaLZG295Av6Wtpb4bDEJne4V61EyYY3F28OXLfq2Ui5tC9hQjzrSs2em6gS07m5rRr_-hT8uaZr7O6caargYDhil9oHxack40urdfcKDcnyzcIQvHWbi_Wbg9i8xBlBmed5T-Wb-jegX0rI5K</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Vermeijden, Harmen D.</creator><creator>Cerniglia, Brett</creator><creator>Mintz, Douglas N.</creator><creator>Rademakers, Maarten V.</creator><creator>Kerkhoffs, Gino M. M. J.</creator><creator>van der List, Jelle P.</creator><creator>DiFelice, Gregory S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9559-757X</orcidid></search><sort><creationdate>20210901</creationdate><title>Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears</title><author>Vermeijden, Harmen D. ; Cerniglia, Brett ; Mintz, Douglas N. ; Rademakers, Maarten V. ; Kerkhoffs, Gino M. M. J. ; van der List, Jelle P. ; DiFelice, Gregory S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-7212f1c6c77a5461162df13f6fba11bad58326b31b8e86eb9d3a196b0a2f2a113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Algorithms</topic><topic>Anterior cruciate ligament</topic><topic>Confidence intervals</topic><topic>Image reconstruction</topic><topic>Injuries</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Magnetic resonance imaging</topic><topic>Mathematical analysis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Reliability analysis</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Tearing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vermeijden, Harmen D.</creatorcontrib><creatorcontrib>Cerniglia, Brett</creatorcontrib><creatorcontrib>Mintz, Douglas N.</creatorcontrib><creatorcontrib>Rademakers, Maarten V.</creatorcontrib><creatorcontrib>Kerkhoffs, Gino M. M. J.</creatorcontrib><creatorcontrib>van der List, Jelle P.</creatorcontrib><creatorcontrib>DiFelice, Gregory S.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vermeijden, Harmen D.</au><au>Cerniglia, Brett</au><au>Mintz, Douglas N.</au><au>Rademakers, Maarten V.</au><au>Kerkhoffs, Gino M. M. J.</au><au>van der List, Jelle P.</au><au>DiFelice, Gregory S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><date>2021-09-01</date><risdate>2021</risdate><volume>29</volume><issue>9</issue><spage>2967</spage><epage>2975</epage><pages>2967-2975</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears.
Methods
In this case–control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements.
Results
Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55–0.98] and 0.91–0.97 (95% CI 0.78–0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (
p
< 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s).
Conclusion
This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively.
Level of evidence
III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00167-020-06312-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9559-757X</orcidid></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021-09, Vol.29 (9), p.2967-2975 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2451854634 |
| source | Wiley Online Library Journals Frontfile Complete; SpringerLink Journals - AutoHoldings |
| subjects | Algorithms Anterior cruciate ligament Confidence intervals Image reconstruction Injuries Knee Ligaments Magnetic resonance imaging Mathematical analysis Medicine Medicine & Public Health Orthopedics Patients Reliability analysis Sports Medicine Surgery Tearing |
| title | Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears |
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