Pisit Lertwanich

Anterior Cruciate Ligament Tunnel Position Measurement Reliability on 3-Dimensional Reconstructed Computed Tomography

PURPOSE The purpose of this study was to evaluate intraobserver and interobserver reliability of anterior cruciate ligament tunnel location measurement by use of 3-dimensional reconstructed computed tomography (CT). METHODS Three-dimensional reconstructed CT images of 31 cadaveric knees were used in this study. Twenty-one knees were operated on with a double-bundle technique, and ten knees were operated on with a single-bundle technique. Femoral tunnel location was measured with 3 methods on the medial-lateral view of the lateral femoral condyle in the strictly lateral position. Tibial tunnel location was measured in the top view of the proximal tibia. The images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed, by both testers, after a 4-week interval. RESULTS The 3 methods of femoral tunnel location measurement had intraobserver intraclass correlation coefficients (ICCs) that ranged from 0.963 to 0.998 and interobserver ICCs that ranged from 0.993 to 0.999. Tibial tunnel measurement had intraobserver ICCs that varied between 0.957 and 0.998 and interobserver ICCs that varied between 0.993 and 0.996. CONCLUSIONS The measurement of the anterior cruciate ligament tunnel location on 3-dimensional reconstructed CT provided excellent intraobserver and interobserver reliability. CLINICAL RELEVANCE Three-dimensional reconstructed CT can be used for further studies to assess the effect of tunnel position on knee stability and patient outcomes.

Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction.

Labral tears are an important cause of hip pain in the athlete. Knowledge of labral function is now better understood. The labrum acts as a suction seal stabilizing the hip joint. After a detailed history and physical examination, imaging workup is done to achieve an accurate diagnosis. Hip arthroscopy can be performed to treat labral tears in a minimally invasive manner. This article describes operative techniques to treat labral tears, including a method for labral reconstruction using the iliotibial band autograft.

Femoroacetabular Impingement: The Femoral Side

Femoroacetabular impingement is an abnormal conflict of the acetabular rim and the femoral head-neck junction. This condition causes labral and cartilage damage and leads to early osteoarthritis of the hip. Femoral osteoplasty is performed to restore normal femoral head-neck offset while the amount of bony resection is monitored by periodic examination. Dynamic examination of the area of impingement, which cannot be performed in open treatment of cam impingement, confirms adequate resection and labral seal through hip range of motion.

Correlation Between the 2-Dimensional Notch Width and the 3-Dimensional Notch Volume: A Cadaveric Study

PURPOSE The purpose of this study was to compare the size of the entrance of the notch, as measured arthroscopically (2-dimensionally), with the volume of the notch as measured by use of computed tomography (CT) (3-dimensionally). METHODS For 20 cadaveric knees, the dimensions of the notch entrance were measured arthroscopically, and the notch volume was measured by use of CT. The correlation between the size of the notch entrance and the notch volume was calculated. Intraobserver reliability and interobserver reliability of the arthroscopic and CT measurements were tested. RESULTS The Pearson correlation coefficients between CT-assessed notch volume and arthroscopically assessed notch height and width at the bottom, middle, and top of the notch were 0.603, 0.506, 0.551, and 0.642, respectively. The intraobserver reliability and interobserver reliability of the arthroscopic measurements were above 0.962 and 0.819, respectively, and 0.983 and 0.975, respectively, for the CT measurements. CONCLUSIONS There were only moderate correlations between arthroscopic notch measurements and notch volume. Both the arthroscopic and CT measurements proved highly reliable. CLINICAL RELEVANCE The moderate correlation between 2-dimensional and 3-dimensional notch measurements warrants caution concerning the use of either measurement for assessing risk for anterior cruciate ligament injury or as justification for notchplasty until studies between the relation of 3-dimensional notch volume and anterior cruciate ligament injury are conducted.

A Biomechanical Comparison of 2 Femoral Fixation Techniques for Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: Over-the-Top Fixation Versus Transphyseal Technique

PURPOSE The purpose of this study was to compare knee kinematics and in situ forces of the graft between 2 femoral fixation techniques of anterior cruciate ligament (ACL) reconstruction: the over-the-top (OTT) fixation and transphyseal (TP) techniques. METHODS ACL reconstruction in skeletally immature patients is a challenging procedure. Regarding the femoral fixation techniques, 2 methods are commonly used: the OTT fixation and TP techniques. Ten cadaveric knees (mean age, 57 years; range, 48 to 65 years) were tested with the robotic/universal force-moment sensor system by use of (1) an 89-N anterior tibial load at full extension and 15°, 30°, 60°, and 90° of knee flexion and (2) a combined 7-Nm valgus torque and 5-Nm internal tibial rotation torque at 15° and 30° of knee flexion. RESULTS Both OTT and TP ACL reconstruction techniques closely restored the intact knee kinematics and had a significant reduction in anterior tibial translation under an anterior tibial load and in coupled anterior tibial translation under a combined rotatory load when compared with an ACL-deficient knee. When both ACL reconstruction techniques were compared, the only difference found was that the in situ force of the ACL graft reconstructed with the OTT technique in response to a combined rotatory load at 30° of flexion was significantly lower than the ACL graft reconstructed with the TP technique (5.3 ± 3.3 N and 10.7 ± 6.0 N, respectively; P = .013). CONCLUSIONS This time 0 testing showed that both ACL reconstruction techniques, OTT and TP, can reproduce the kinematics of the intact knee in response to an anterior tibial load and a combined rotatory load. CLINICAL RELEVANCE Both femoral fixation techniques exhibited comparable time 0 kinematics when subjected to simulated clinical examination loading conditions.

Anterolateral ligament anatomy: a comparative anatomical study

AbstractPurpose Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens.MethodsFifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner.ResultsAn ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs.ConclusionThe clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.