Surgical and Radiologic Anatomy

, Volume 30, Issue 7, pp 557–562 | Cite as

Inter-observer agreement in the identification of the two bundles of the anterior cruciate ligament using magnetic resonance imaging

  • M. Montoy
  • T. Euvrard
  • B. Moyen
  • P. Roy
  • J. C. Rollier
  • F. Cotton
Original Article



Magnetic resonance imaging has become the method of choice to diagnose meniscal and ligament lesions of the knee. New approaches to the surgical treatment of partial anterior cruciate ligament tears led us to try to distinguish the two bundles of that ligament with MRI and to evaluate inter-observer agreement in different viewing planes.


Images of 50 right and 50 left ligament-intact knees were examined in the coronal and axial viewing planes. Each sequence was independently read by a radiologist and a medical student to note, in each viewing plane, the number of images in which the two-bundle structure of the ligament was clearly seen. Cohen’s Kappa coefficients were used to determine inter-observer agreements.


The percentage of sequences in which the two bundles were distinguished by the radiologist and the student on one image at least were 82 versus 73% in the coronal plane and 90 versus 93% in the axial plane, respectively. The average number of successive images with clear bundles was higher in the axial (2.7 vs. 1.7) than in the coronal plane (2.2 vs. 1). There was a poor inter-observer agreement in the coronal plane (k = 0.176) but an intermediate agreement in the axial plane (k = 0.385 or 0.522 depending on number pooling).


The axial viewing plane seems more favourable to distinguish the two bundles of the anterior cruciate ligament with the best possible reproducibility. An oblique-axial plane is deemed to insure a clearer diagnosis of partial tears.


Anterior cruciate ligament Magnetic resonance imaging Knee Sports medicine 


  1. 1.
    Amis AA, Dawkins GPC (1991) Functional anatomy of the anterior cruciate ligament. J Bone Joint Surg 73(2):260–267Google Scholar
  2. 2.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:27–46CrossRefGoogle Scholar
  3. 3.
    Drapé JL, Godefroy D, Dupont AM, Chevrot A (1999) Radio-anatomie du genou. Encyclopédie Médico Chirurgicale 80(6 Suppl):628–639Google Scholar
  4. 4.
    Duc SR, Zanetti M, Kramer J, Kach KP, Zollikofer CL, Wentz KU (2005) Magnetic resonance imaging of the anterior cruciate ligament tears: evaluation of standard orthogonal and tailored paracoronal images. Acta Radiol 46(7):729–733PubMedCrossRefGoogle Scholar
  5. 5.
    Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Menetrey J (2006) Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:204–213PubMedCrossRefGoogle Scholar
  6. 6.
    Giris FG, Marshall JL, Al Monajem ARS (1975) The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231CrossRefGoogle Scholar
  7. 7.
    Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256PubMedCrossRefGoogle Scholar
  8. 8.
    Hollis JM, Takai S, Adam DJ, Horibe S, Woo SL (1991) The effects of knee motion and external loading on the length of the anterior cruciate ligament (ACL): a kinematic study. J Biomech Eng 113:208–214PubMedCrossRefGoogle Scholar
  9. 9.
    Hong SH, Choi JY, Lee GK, Choi JA, Chung HW, Kang HS (2003) Grading of anterior cruciate ligament injury. Diagnostic efficacy of oblique coronal magnetic resonance imaging of the knee. J Comput Assist Tomogr 27(5):814–819PubMedCrossRefGoogle Scholar
  10. 10.
    Katahira K, Yamashita Y, Takahashi M et al (2001) MR imaging of the anterior cruciate ligament: value of thin slice direct oblique coronal technique. Radiat Med 19(1):1–7PubMedGoogle Scholar
  11. 11.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  12. 12.
    Lee JK, Yao L, Phelps CT, Writh CR, Czajka J, Lozman J (1988) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 166:861–864PubMedGoogle Scholar
  13. 13.
    Lerman JE, Gray DS, Schweitzer ME, Bartolozzi A (1995) MR evaluation of the anterior cruciate ligament: value of axial images. J Comput Assist Tomogr 19(4):604–607PubMedCrossRefGoogle Scholar
  14. 14.
    Mellado JM, Calmet J, Olona M, Gine J, Saturi A (2004) Magnetic resonance imaging of anterior cruciate ligament: reevaluation of quantative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle. Knee Surg Sports Traumatol Arthrosc 12(3):217–224PubMedCrossRefGoogle Scholar
  15. 15.
    Odensten M, Gillquist J (1985) Functionnal anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262PubMedGoogle Scholar
  16. 16.
    Polly DW Jr, Callaghan JJ, Sikes RA, McCabe JM, McMahon K, Savory CG (1988) The accuracy of selective magnetic resonance imaging compared with the findings of arthtroscopy of the knee. J Bone Joint Surg Am 70:192–197PubMedGoogle Scholar
  17. 17.
    Reicher MA, Rauschning W, Gold RH (1985) High-resolution magnetic resonance imaging of the knee joint: normal anatomy. Am J Roentgenol 145:895–902Google Scholar
  18. 18.
    Starman JS, VanBeek C, Armfield DR, Sahasrabudhe A, Baker CLIII, Irrgang JJ, Fu FH (2007) Assessment of normal ACL double anatomy in standard viewing planes by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 167(6):266–268Google Scholar
  19. 19.
    Steckel H, Vadala G, Davis D, Fu FH (2006) 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc 14:1151–1158PubMedCrossRefGoogle Scholar
  20. 20.
    Turner DA, Prodromos CC, Petasnik JP, Clark JW (1985) Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 154(4):717–722PubMedGoogle Scholar
  21. 21.
    Umans H, Wimpfheimer O, Haramati N, Applbaum YH, Adler M, Bosco J (1995) Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. Am J Roentgenol 165(4):893–897Google Scholar
  22. 22.
    Vaz CES, de Camargo OP, de Santana PJ, Valei AC (2005) Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions. Clinics 60(6):445–450PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • M. Montoy
    • 1
  • T. Euvrard
    • 2
  • B. Moyen
    • 3
  • P. Roy
    • 4
    • 5
    • 6
  • J. C. Rollier
    • 3
  • F. Cotton
    • 1
    • 2
    • 7
  1. 1.Laboratoire d’Anatomie de RockefellerUniversité Claude Bernard Lyon 1Lyon Cedex 08France
  2. 2.Service de Radiologie et IRMHospices Civils de Lyon, Centre Hospitalier Lyon-SudPierre-BéniteFrance
  3. 3.Service de Chirurgie OrthopédiqueHospices Civils de Lyon, Centre Hospitalier Lyon-SudPierre-BéniteFrance
  4. 4.Service de BiostatistiqueHospices Civils de LyonLyonFrance
  5. 5.Université de Lyon, Université Lyon IVilleurbanneFrance
  6. 6.Laboratoire Biostatistique SantéCNRS, UMR 5558Pierre-BéniteFrance
  7. 7.CREATIS, INSA-502VilleurbanneFrance

Personalised recommendations