Evaluation of bone plug integration after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft with tomosynthesis -Comparative study with CT reconstructed image-
Author(s):
Toyooka S. (Japan)
,
Toyooka S. (Japan)
Affiliations:
Masuda H.
,
Masuda H.
Affiliations:
Nishihara N.
,
Nishihara N.
Affiliations:
Yonemoto T.
,
Yonemoto T.
Affiliations:
Shimazaki N.
,
Shimazaki N.
Affiliations:
Kawano H.
,
Kawano H.
Affiliations:
Nakagawa T.
Nakagawa T.
Affiliations:
ESSKA Academy. Toyooka S. 05/09/18; 209390; P04-740 Topic: Arthroscopic Surgery
Seikai Toyooka
Seikai Toyooka
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Abstract
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Objectives: Evaluation of bone integration after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft is important to plan post-operative therapy. Standard radiography remains the basic imaging tool, but lacks sensitivity and specificity. CT is an efficient tool for evaluating bone healing between bone plug and bone tunnel. But its cost and radiation exposure are much higher than standard radiography. Tomosynthesis involves seeping the x-ray tube over an angular range of about 50 degree to reconstruct a series of slices of single planes and considerably less irradiation than CT. It is increasingly of interest in diagnosing bone healing and is already used in routine clinical practice to image the chest and for musculoskeletal indications and is beginning to be used for the breast. To the best of our knowledge, no articles in the literature consider the use of this new technology in the diagnosis of bone plug healing after ACL reconstruction. The purpose of the study was to clarify the diagnostic value of tomosynthesis in bone plug healing after ACL reconstruction with BPTB graft.

Methods: Consecutive 24 patients who underwent ACL reconstruction with BPTB between January 2017 and September 2017 were enrolled. Bone union between bone plug and bone tunnel were evaluated by tomosynthesis and CT, which were undergone simultaneously at 3 months after the operation. The obtained image data in both modality was reconstructed with 2 mm thick in coronal and sagittal plane. The ratio of bone healing on the reconstructed slices obtained from tomosynthesis and CT was investigated. The slice was defined as bone healing when there was any bone trabeculae continuity between the bone plug and bone tunnel. Evaluation of bone healing was carried out using coronal and sagittal reconstructed images in femur and tibia. All imaging was independently reviewed by two blinded orthopaedic surgeon. Interobserver agreement was assessed with intraclass correlation coefficients (ICC), the intermodality differences with Spearman correlation test.

Results: Twenty four CT and tomosynthesis were reviewed. Femoral coronal and sagittal inter-observer agreement for CT was ICC = 0.81, 0.92, for tomosynthesis ICC = 0.82, 0.76. Tibial coronal and sagittal inter-observer agreement for CT was ICC = 0.74, 0.96, for tomosynthesis ICC = 0.73, 0.89. The correlation between tomosynthesis and CT was found in all of the femoral and tibial coronal and sagittal images.

Conclusions: There were correlation in evaluation of bone plug healing after BPTB ACL reconstruction between tomosynthesis and CT. These results demonstrate that tomosynthesis could be as effective as CT in identifying bone plug healing. Tomosynthesis is cheaper, has lower radiation exposure, requires fewer hospital resources and can be performed quickly in comparison with CT, which is suitable for serial evaluation.

Keywords:
anterior cruciate ligament reconstruction, tomosynthesis, bone-patellar tendon-bone,
Objectives: Evaluation of bone integration after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft is important to plan post-operative therapy. Standard radiography remains the basic imaging tool, but lacks sensitivity and specificity. CT is an efficient tool for evaluating bone healing between bone plug and bone tunnel. But its cost and radiation exposure are much higher than standard radiography. Tomosynthesis involves seeping the x-ray tube over an angular range of about 50 degree to reconstruct a series of slices of single planes and considerably less irradiation than CT. It is increasingly of interest in diagnosing bone healing and is already used in routine clinical practice to image the chest and for musculoskeletal indications and is beginning to be used for the breast. To the best of our knowledge, no articles in the literature consider the use of this new technology in the diagnosis of bone plug healing after ACL reconstruction. The purpose of the study was to clarify the diagnostic value of tomosynthesis in bone plug healing after ACL reconstruction with BPTB graft.

Methods: Consecutive 24 patients who underwent ACL reconstruction with BPTB between January 2017 and September 2017 were enrolled. Bone union between bone plug and bone tunnel were evaluated by tomosynthesis and CT, which were undergone simultaneously at 3 months after the operation. The obtained image data in both modality was reconstructed with 2 mm thick in coronal and sagittal plane. The ratio of bone healing on the reconstructed slices obtained from tomosynthesis and CT was investigated. The slice was defined as bone healing when there was any bone trabeculae continuity between the bone plug and bone tunnel. Evaluation of bone healing was carried out using coronal and sagittal reconstructed images in femur and tibia. All imaging was independently reviewed by two blinded orthopaedic surgeon. Interobserver agreement was assessed with intraclass correlation coefficients (ICC), the intermodality differences with Spearman correlation test.

Results: Twenty four CT and tomosynthesis were reviewed. Femoral coronal and sagittal inter-observer agreement for CT was ICC = 0.81, 0.92, for tomosynthesis ICC = 0.82, 0.76. Tibial coronal and sagittal inter-observer agreement for CT was ICC = 0.74, 0.96, for tomosynthesis ICC = 0.73, 0.89. The correlation between tomosynthesis and CT was found in all of the femoral and tibial coronal and sagittal images.

Conclusions: There were correlation in evaluation of bone plug healing after BPTB ACL reconstruction between tomosynthesis and CT. These results demonstrate that tomosynthesis could be as effective as CT in identifying bone plug healing. Tomosynthesis is cheaper, has lower radiation exposure, requires fewer hospital resources and can be performed quickly in comparison with CT, which is suitable for serial evaluation.

Keywords:
anterior cruciate ligament reconstruction, tomosynthesis, bone-patellar tendon-bone,
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