Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information

  • Michael T. HirschmannEmail author
  • Dominic Mathis
  • Faik K. Afifi
  • Helmut Rasch
  • Johann Henckel
  • Felix Amsler
  • Christopher R. Wagner
  • Niklaus F. Friederich
  • Markus P. Arnold
Experimental Study



The purpose of this study was to introduce a novel standardized algorithm using SPECT/CT, which promises the potential combined assessment of the biology of the joint in particular the bone-graft-fixation complex and the 3D tunnel placement in patients after ACL reconstruction. Its clinical application and inter- and intra-observer reliability should be critically evaluated.


A novel SPECT/CT localization scheme consisting of 13 tibial, 9 femoral and 4 patellar regions on standardized axial, coronal and sagittal slices is proposed. The tracer activity on SPECT/CT was localized and recorded in 25 consecutive patients using a 3D volumetric and quantitative analysis software. The inter- and intra-observer reliability was assessed for localization and tracer activity. The tunnel position was assessed in 3D-CT using standardized frames of reference. The inter- and intra-observer reliability (OR) of the measured distances were calculated (ICC).


The localization scheme for tracer uptake analysis was useful and easily applicable in all 25 knees. It showed very high inter-OR and intra-ORs for all regions (ICC > 0.80). Tibial and femoral tunnel position measurements showed strong agreement between the readings of the two observers; the ICCs for the position, angulation, length and entry point of the femoral tunnel were >0.88 (intra-OR) and >0.86 (inter-OR). The ICC for the position of the tibial tunnel (angulation, length and entry point) was >0.79 (intra-OR) and >0.74 (inter-OR).


The SPECT/CT algorithm presented is highly reliable and clinically feasible. Combining the 3D-mechanical information on tunnel placement and attachment areas and the 3D metabolic data will be helpful in evaluating patients with pain after ACL reconstruction.


SPECT/CT Anterior cruciate ligament reconstruction Diagnostics 3D-CT Tracer uptake distribution 3D volumetric analysis 



We greatly thank the Deutsche Arthrose Hilfe e.V, Saarlouis, Germany as well as the Alwin-Jäger-Stiftung, Aschaffenburg, Germany for supporting our research and Jürg Schmutz, Bruderholz for his illustrative work.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Michael T. Hirschmann
    • 1
    Email author
  • Dominic Mathis
    • 1
  • Faik K. Afifi
    • 1
  • Helmut Rasch
    • 2
  • Johann Henckel
    • 3
  • Felix Amsler
    • 4
  • Christopher R. Wagner
    • 5
  • Niklaus F. Friederich
    • 1
  • Markus P. Arnold
    • 1
  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital BruderholzBruderholzSwitzerland
  2. 2.Institute of Radiology and Nuclear MedicineKantonsspital BruderholzBruderholzSwitzerland
  3. 3.Imperial College LondonLondonUK
  4. 4.Amsler ConsultingBaselSwitzerland
  5. 5.OrthoImagingSolutions Ltd.LondonUK

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