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The quadrant method measuring four points is as a reliable and accurate as the quadrant method in the evaluation after anatomical double-bundle ACL reconstruction

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

Abstract

Purpose

The quadrant method was described by Bernard et al. and it has been widely used for postoperative evaluation of anterior cruciate ligament (ACL) reconstruction. The purpose of this research is to further develop the quadrant method measuring four points, which we named four-point quadrant method, and to compare with the quadrant method.

Methods

Three-dimensional computed tomography (3D-CT) analyses were performed in 25 patients who underwent double-bundle ACL reconstruction using the outside-in technique. The four points in this study’s quadrant method were defined as point1—highest, point2—deepest, point3—lowest, and point4—shallowest, in femoral tunnel position. Value of depth and height in each point was measured. Antero-medial (AM) tunnel is (depth1, height2) and postero-lateral (PL) tunnel is (depth3, height4) in this four-point quadrant method. The 3D-CT images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed by both observers after a 4-week interval. Intra- and inter-observer reliability was calculated by means of intra-class correlation coefficient (ICC). Also, the accuracy of the method was evaluated against the quadrant method.

Results

Intra-observer reliability was almost perfect for both AM and PL tunnel (ICC > 0.81). Inter-observer reliability of AM tunnel was substantial (ICC > 0.61) and that of PL tunnel was almost perfect (ICC > 0.81). The AM tunnel position was 0.13% deep, 0.58% high and PL tunnel position was 0.01% shallow, 0.13% low compared to quadrant method.

Conclusions

The four-point quadrant method was found to have high intra- and inter-observer reliability and accuracy. This method can evaluate the tunnel position regardless of the shape and morphology of the bone tunnel aperture for use of comparison and can provide measurement that can be compared with various reconstruction methods. The four-point quadrant method of this study is considered to have clinical relevance in that it is a detailed and accurate tool for evaluating femoral tunnel position after ACL reconstruction.

Level of Evidence

Case series, Level IV.

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Authors and Affiliations

  1. Department of Orthopaedics Surgery (Ohashi), School of Medicine, Toho University, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Yuta Mochizuki, Takao Kaneko, Keisuke Kawahara, Shinya Toyoda, Norihiko Kono, Masaru Hada, Hiroyasu Ikegami & Yoshiro Musha

Authors
  1. Yuta Mochizuki
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  2. Takao Kaneko
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  3. Keisuke Kawahara
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  7. Hiroyasu Ikegami
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Correspondence to Yuta Mochizuki.

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The authors declare that they have no conflict of interest.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

Ethical approval

The study was approved by the Ethics Committee of Toho University Ohashi Medical Center (No. H16110).

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Patient were informed, and they consented to conduct the study.

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Mochizuki, Y., Kaneko, T., Kawahara, K. et al. The quadrant method measuring four points is as a reliable and accurate as the quadrant method in the evaluation after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 2389–2394 (2018). https://doi.org/10.1007/s00167-017-4797-y

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