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Three-dimensional isotropic magnetic resonance imaging can provide a reliable estimate of the native anterior cruciate ligament insertion site anatomy

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study quantified the error in anterior cruciate ligament (ACL) insertion site location and area estimated from three-dimensional (3D) isotropic magnetic resonance imaging (MRI) by comparing to native insertion sites determined via 3D laser scanning.

Methods

Isotropic 3D DESS MRI was acquired from twelve fresh-frozen, ACL-intact cadaver knees. ACL insertion sites were manually outlined in each MRI slice, and the resulting contours combined to determine the 3D insertion site shape. Specimens were then disarticulated, and the boundaries of the ACL insertion sites were digitized using a high-accuracy laser scanner. MRI and laser scan insertion sites were co-registered to determine the percent overlapping area and difference in insertion centroid location.

Results

Femoral ACL insertion site area averaged 112.7 ± 17.9 mm2 from MRI and 109.7 ± 10.9 mm2 from laser scan (p = 0.345). Tibial insertion area was 134.7 ± 22.9 mm2 from MRI and 135.2 ± 15.1 mm2 from laser scan (p = 0.881). Percentages of overlapping area between modalities were 82.2 ± 10.2% for femurs and 81.0 ± 9.0% for tibias. The root-mean-square differences for ACL insertion site centroids were 1.87 mm for femurs and 2.49 mm for tibias. The MRI-estimated ACL insertion site centroids were biased on average 0.6 ± 1.6 mm proximally and 0.3 ± 1.9 mm posteriorly for femurs, and 0.3 ± 1.1 mm laterally and 0.5 ± 1.5 mm anteriorly for tibias.

Conclusion

Errors in ACL insertion site location and area estimated from 3D-MRI were determined via comparison with a high-accuracy 3D laser scanning. Results indicate that MRI can provide estimates of ACL insertion site area and centroid location with clinically applicable accuracy. MRI-based assessment can provide a reliable estimate of the native ACL anatomy, which can be helpful for surgical planning as well as assessment of graft tunnel placement.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Pittsburgh, 3820 S Water St., Pittsburgh, PA, 15206, USA

    Daisuke Araki, Eric Thorhauer & Scott Tashman

  2. Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Daisuke Araki

  3. Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, Houston, USA

    Scott Tashman

Authors
  1. Daisuke Araki
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  2. Eric Thorhauer
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  3. Scott Tashman
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Correspondence to Scott Tashman.

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Conflict of interest

The authors have no conflicts of interest directly relevant to the content of this article.

Funding

This study was funded by a Pittsburgh Foundation Grant (M2012-0022).

Ethical approval

The committee for oversight of research and clinical training involving decedents has reviewed and approved the above-referenced study.

Informed consent

Not applicable in this study.

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Araki, D., Thorhauer, E. & Tashman, S. Three-dimensional isotropic magnetic resonance imaging can provide a reliable estimate of the native anterior cruciate ligament insertion site anatomy. Knee Surg Sports Traumatol Arthrosc 26, 1311–1318 (2018). https://doi.org/10.1007/s00167-017-4560-4

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  • DOI: https://doi.org/10.1007/s00167-017-4560-4

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