2D, 3D MRI may accurately measure ACL foot plate anatomy before surgery
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Despite small differences in anterior tibial and inter-meniscal ligament measurements, both 2D and 3D MRI may be used to delineate ACL foot plate anatomy for preoperative graft placement planning, according to published results.
To examine radiological measurements for the native ACL tibial footprint, researchers from UT Southwestern Medical Center performed a retrospective analysis of 101 knee MRIs with 2D and 3D imaging in 43 men and 66 women (mean age, 39.5 years) from November 2018 to November 2020.
Researchers analyzed differences in measurements from 2D and 3D MRIs (on a 3-Tesla scanner) for tibial to ACL (T-ACL) and inter-meniscal ligament to ACL (IM-ACL) distances. Researchers also compared measurements in an additional cohort of 18 patients who underwent knee arthroscopy. T-ACL and IM-ACL distances in this cohort were determined by the surgeon using a standard scale.
Measurements and mean differences
From reader 1, the mean difference in ICC between T-ACL and IM-ACL measurements was 1.17 mm from 2D MRI and 1.03 mm from 3D MRI. From reader 2, the mean difference between T-ACL and IM-ACL measurements was 0.65 mm from 2D MRI and 0.65 mm from 3D MRI. Researchers noted mean arthroscopic IM-ACL was closer to measurements on 3D MRI compared with 2D MRI, whereas T-ACL was closer to measurements on 2D MRI compared with 3D MRI.
Inter-reader reliability
Researchers used intra-class correlation coefficient (ICC) to analyze inter-reader agreement and inter-sequence agreement. Inter-reader reliability was deemed excellent for T-ACL (0.81) and IM-ACL (0.96) measurements on 2D MRI, while inter-reader reliability was deemed fair for T-ACL (0.59) and excellent for IM-ACL (0.9) measurements on 3D MRI.
“This study is the first one to use 3D MRI and in vivo arthroscopy to determine ACL tunnel foot plate anatomy to facilitate presurgical planning,” the researchers wrote in the study. “However, both 2D and 3D MRI showed inter-reader reliability with small inter-modality mean differences in the measurements from both anterior tibial and inter-meniscal ligament margins,” they wrote.
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