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The medial epicondyle of the distal femur is the optimal location for MRI measurement of semitendinosus and gracilis tendon cross-sectional area

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Graft diameter ≥ 8 mm reduces the risk of failure after anterior cruciate ligament reconstruction (ALCR) with hamstring tendon autograft. Pre-operative measurement of gracilis (GT) and semitendinosus (ST) cross-sectional area using MRI has been utilized but the optimal location for measurement is unknown. The main purpose of this study was to examine the cross-sectional areas of GT + ST at different locations and develop a model to predict whether a doubled hamstring graft of GT + ST will be of sufficient cross-sectional area for ACLR.

Methods

A retrospective review was performed of 154 patients who underwent primary ACLR using doubled hamstring autograft. Cross-sectional area measurements of GT + ST on pre-operative MRI axial images were made at three locations: medial epicondyle (ME), tibiofemoral joint line (TJL), and tibial physeal scar (TPS) and calculated the correlation of intra-operative graft size for each location using the Pearson’s correlation coefficient. A receiver operating characteristic (ROC) established a threshold that would predict graft diameter ≥ 8 mm.

Results

Measurement of GT + ST at the ME had a stronger correlation (r = 0.389) to intra-operative graft diameter than measurements at the TJL (r = 0.256) or TPS (r = 0.240). The ROC indicated good predictive value for hamstring graft diameter ≥ 8 mm based on MRI measurement at the ME with the optimal threshold with the highest sensitivity and specificity as 18 mm2.

Conclusion

Cross-sectional area measurement of GT + ST at the ME correlated most closely to intra-operative diameter of a doubled hamstring autograft compared to measurements at the TJL or the TPS. As graft diameter < 8 mm is correlated with higher failure rates of ACL surgery, the ability to pre-operatively predict graft diameter is clinically useful.

Level of evidence

Level III, prognostic study.

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Abbreviations

ACL:

Anterior cruciate ligament

GT:

Gracilis tendon

ST:

Semitendinosus

MRI:

Magnetic resonance imaging

CT:

Computed tomography

BMI:

Body mass index

ROC:

Receiver operating characteristic

AUC:

Area under the curve

ANOVA:

Analysis of variance

ICC:

Intraclass correlation coefficient (ICC)

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Funding

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA

    Clayton T. Hodges, Trevor J. Shelton, Cassandra A. Lee, Brian M. Haus & Richard A. Marder

  2. Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Cyrus P. Bateni, Stephen S. Henrichon & Robert D. Boutin

  3. School of Medicine at University of California at Davis, Sacramento, CA, 95817, USA

    Alton W. Skaggs

Authors
  1. Clayton T. Hodges
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  2. Trevor J. Shelton
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  3. Cyrus P. Bateni
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  4. Stephen S. Henrichon
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  6. Robert D. Boutin
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  7. Cassandra A. Lee
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  8. Brian M. Haus
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  9. Richard A. Marder
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Contributions

All authors (1) have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, (2)have been involved in drafting the manuscript or revising it critically for important intellectual content, (3) have given final approval of the version to be published, (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Trevor J. Shelton.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional review board (IRB) at our institution.

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Hodges, C.T., Shelton, T.J., Bateni, C.P. et al. The medial epicondyle of the distal femur is the optimal location for MRI measurement of semitendinosus and gracilis tendon cross-sectional area. Knee Surg Sports Traumatol Arthrosc 27, 3498–3504 (2019). https://doi.org/10.1007/s00167-019-05421-6

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  • DOI: https://doi.org/10.1007/s00167-019-05421-6

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