Painful knee joint after ACL reconstruction using biodegradable interference screws- SPECT/CT a valuable diagnostic tool? A case report

Hirschmann, Michael T.; Adler, Tom; Rasch, Helmut; Hügli, Rolf; Friederich, Niklaus F.; Arnold, Markus

doi:10.1186/1758-2555-2-24

Cited by 27 publications

(51 citation statements)

References 35 publications

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“…Hirschmann et al highlighted the clinical potential of SPECT/CT imaging in evaluating tunnel widening after ACL reconstruction 13 . It promises the potential assessment of the biology of the joint and particularly the integration or healing of the bone-graft-fixation complex, which might be beneficial in patients with biocompatible interference screws 13 .…”

Section: Spect/ctmentioning

confidence: 99%

“…It promises the potential assessment of the biology of the joint and particularly the integration or healing of the bone-graft-fixation complex, which might be beneficial in patients with biocompatible interference screws 13 . The measurement of tunnel width was performed descriptively, but correlated with additional information from SPECT about joint homeostasis 13 .…”

Section: Spect/ctmentioning

confidence: 99%

“…In the last decade magnetic resonance imaging (MRI) and computed tomography (CT) were increasingly used for evaluation of tunnel widening, as these promised higher accuracy and lower inter-or intra-observer variabilities 9,10,18,45 . Only few Authors have used bone scans, single-photon emission tomography (SPECT) or multi-modality imaging such as SPECT/CT to follow-up their patients after ACL reconstruction 11,13 . A variety of different algorithms and measurement methods using conventional radiographs, MRI or CT, whether in 2D or 3D have been described to evaluate bone tunnel widening 1-4, 6-10, 13, 15, 17-20, 22, 23, 26, 28-33, 37-47 .…”

Section: Introductionmentioning

confidence: 99%

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How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Michael

2017

MLTJ

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SummaryBackground: Comparing different imaging modalities and methods for assessment tunnel widening after ACL reconstruction and providing a detailed evidence-based literature overview. Methods: PubMed was searched from 1970 to 2016 using the terms "ACL reconstruction" and "tunnel" and "imaging" or "CT" or "computerized tomography" or "MRI" or "magnetic resonance imaging" or "radiographs". 647 studies were found. 575 articles were excluded due to absence of specific radiological measurement methods of tunnel widening and 40 due to repetition of a previously published radiological measurement method. 32 articles were included reporting interand intraobserver reliabilities of tunnel measurement methods after ACL reconstruction. Results: A variety of different algorithms and measurement methods using radiographs, magnetic resonance imaging, computed tomography or SPECT/CT evaluating tunnel position and bone tunnel enlargement have been described. Tunnel delination restricts an exact analysis using X-ray. Measurements using CT or MR were mostly obtained perpendicular to the tunnel axis or using specialized software for tunnel volume calculation in 3D. Based on the review the width of the femoral and tibial tunnels should be assessed perpendicular to the tunnel axis at different levels in relation to the joint. At least one measurement should be performed at the tunnel entrance, exit and midpoint of the tunnel. Conclusion: CT should be considered the gold standard assessing tunnel widening in patients after ACL reconstruction. If specialized software is available calculating the tunnel volume, measurements should be preferably performed in 3D CT. Level of evidence: II.

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Section: Spect/ctmentioning

confidence: 99%

Section: Spect/ctmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How to evaluate bone tunnel widening after ACL reconstruction - a critical review

Michael

2017

MLTJ

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“…SPECT/CT allows accurate anatomical localisation of metabolic tracer activity [9]. Recently, we have introduced a novel diagnostic SPECT/CT algorithm for the challenging group of patients with problems after ACL reconstruction [6,9,14,15]. This standardised algorithm including grading and anatomical localization of SPECT/CT tracer uptake promises the identification of specific pathological tracer uptake patterns and distributions [9].…”

Section: Introductionmentioning

confidence: 99%

“…Typical reasons include failure of the ACL graft, failure of graft fixation, chronic synovitis due to biodegradable fixation material and missed concomitant injuries [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Hirschmann

Mathis

Rasch

et al. 2012

International Orthopaedics (SICOT)

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Purpose SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT). SPECT/CT allows accurate anatomical localisation of metabolic tracer activity. It allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors. The purpose of this study was to investigate whether the SPECT/CT tracer uptake (intensity and distribution) correlates with the stability and laxity of the knee joint and the position and orientation of the tibial and femoral tunnels in patients after anterior cruciate ligament (ACL) reconstruction. Methods A consecutive series of knees (n066), with symptoms of pain and/or instability after ACL reconstruction were prospectively evaluated using clinical examination and 99mTc-HDP-SPECT/CT. Clinical laxity testing was performed using the Rolimeter (Ormed, Freiburg, Germany) including Lachman testing (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), anterior drawer test (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), pivot shift test (positive versus negative) and patientbased subjective instability (yes versus no).For analysis of SPECT/CT tracer uptake a previously validated SPECT/CT localisation scheme consisting of 17 tibial, nine femoral and four patellar regions on standardised axial, coronal, and sagittal slices was used. The tracer activity on SPECT/CT was localised and recorded using a 3D volumetric and quantitative analysis software.Mean, standard deviation, minimum and maximum of grading for each area of the localisation scheme were recorded. The position and orientation of the tibial and femoral tunnel was assessed using a previously published method on 3D-CT. Results Correlation of instability, pivot shift as well as clinical laxity testing with 99mTc-HDP-SPECT/CT tracer uptake intensity and distribution showed no significant correlation. 99mTc-HDP-SPECT/CT tracer uptake correlated significantly with the position and orientation of the ACL graft. A more horizontal femoral graft position showed significantly increased tracer uptake within the superior and posterior femoral regions. A more posteriorly-placed femoral insertion site showed significantly more tracer uptake within the femoral and tibial tunnel regions. A more vertical or a less medial tibial tunnel orientation showed significant increased uptake within the tibial and femoral tunnel regions. A more anterior tibial tunnel position showed significantly more tracer uptake in the femoral and tibial tunnel regions as well as the entire tibiofemoral joint. Conclusions SPECT/CT tracer uptake intensity and distribution showed a significant correlation with the femoral and tibial tunnel position and orientation in patients with symptomatic knees after ACL reconstruction. No correlation was found with stability or clinical laxity.Michael T. Hirschmann and Dominic Mathis contributed equally to this paper.

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Assessment of loading history of compartments in the knee using bone SPECT/CT: A study combining alignment and 99mTc‐HDP tracer uptake/distribution patterns

Hirschmann

Schön

Afifi

et al. 2012

Journal Orthopaedic Research

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This study investigates if the mechanical/anatomical alignment influences the intensity values as well as the distribution pattern of SPECT/CT tracer uptake. Eighty-five knees (mean age 48 AE 16) undergoing 99mTc-HDP-SPECT/CT due to pain were prospectively included. SPECT/CTs were analyzed using a previously validated localization method. The maximum intensities in each femoral, tibial, and patellar joint compartment (medial, lateral, central, superior, and inferior) were noted using a color-coded grading scale (0-10). The Kellgren-Lawrence osteoarthritis score (KL) was assessed on standardized radiographs. Long leg radiographs were used to assess the mechanical/anatomical leg alignment, which was classified as varus, valgus, or neutral. The alignment and KL was correlated with the intensity of tracer uptake in each area of interest (p < 0.05). The intensity of SPECT/CT tracer uptake in the medial and lateral knee compartment significantly correlated with varus or valgus alignment of the knee. A higher degree of osteoarthritis was significantly related to higher tracer uptake in the corresponding joint compartments. SPECT/CT reflects the specific loading pattern of the knee with regard to its alignment. It is also related to the degree of osteoarthritis. Hence, SPECT/CT should be considered for follow-up of patients after realignment treatments, osteotomies, deloader devices, or insoles. ß

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Painful knee joint after ACL reconstruction using biodegradable interference screws- SPECT/CT a valuable diagnostic tool? A case report

Cited by 27 publications

References 35 publications

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Assessment of loading history of compartments in the knee using bone SPECT/CT: A study combining alignment and 99mTc‐HDP tracer uptake/distribution patterns

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