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No added value using SPECT/CT to analyze persistent symptoms after anterior cruciate ligament reconstruction

  • Christian EgloffEmail author
  • Lukas Huber
  • Markus Wurm
  • Geert Pagenstert
Arthroscopy and Sports Medicine
  • 16 Downloads

Abstract

Purpose

To evaluate the diagnostic and clinical value of SPECT/CT compared to the standard algorithm for patients with persistent symptoms after anterior cruciate ligament reconstructions. The standard algorithm uses clinical information, conventional radiographs, MRI and CT scan, while the trial algorithm uses the same information but SPECT/CT in addition.

Methods

In a diagnostic comparative trial three experienced surgeons evaluated 23 consecutive patients with persistent symptoms after ACL reconstruction using first standard and second the trial algorithm with a time interval. Each rater had to establish a diagnosis and therapeutic decision with each algorithm. On MRI, graft continuity, bone marrow edema, chondral and meniscal lesions, femoral notch osteophytes were evaluated. Bone tracer uptake in SPECT/CT was anatomically analyzed and compared with MRI findings. MRI findings and SPECT/CT tracer uptake were correlated using Spearman’s rho test.

Results

Additional SPECT/CT analysis did not change diagnosis in any case and did not correlate with clinical graft integrity. Treatment decisions remained unchanged as well. Chondral lesions, arthritic changes, meniscal lesions, graft impingement are best visualized in MRI and showed correspondent tracer uptake in SPECT/CT. Tunnel position was well classified with standard CT scan and showed no correlation with SPECT/CT tracer uptake.

Conclusion

Information derived by SPECT/CT in addition to the standard algorithm using clinical information, X-rays, MRI, and CT scan did not change the diagnosis or treatment plan. There is currently no justification to implement SPECT/CT for patients with persistent symptoms after anterior cruciate ligament reconstructions.

Level of evidence

Level II: diagnostic comparative study.

Keywords

Knee ACL Anterior cruciate ligament SPECT/CT MRI 

Notes

Acknowledgements

Data collection and correlation analysis were mainly conducted by the medical student Lukas Huber under the guidance of the first author and final approval and initial set-up of the senior author. This work will be used to apply for the Medical Doctor degree of Lukas Huber (dissertation at the University of Basel, Switzerland).

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christian Egloff
    • 1
    Email author
  • Lukas Huber
    • 2
  • Markus Wurm
    • 3
  • Geert Pagenstert
    • 4
    • 5
    • 6
  1. 1.Department of Orthopedics and TraumatologyUniversity Hospital BaselBaselSwitzerland
  2. 2.University of BaselBaselSwitzerland
  3. 3.Department of Orthopaedic Sports MedicineTechnische Universität München (TUM)MunichGermany
  4. 4.Department of Clinical ResearchUniversity of BaselBaselSwitzerland
  5. 5.Clarahof Clinic of Orthopaedic SurgeryMerian-Iselin-Hospital Swiss Olympic Medical CenterBaselSwitzerland
  6. 6.Knee Institute BaselBaselSwitzerland

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