Regression modelling combining MRI measurements and patient anthropometry for patient screening and prediction of graft diameter in hamstring autograft arthroscopic ACL reconstruction

Abstract

BackgroundPrevious studies have associated anthropometric data and pre-operative hamstring tendon measurements to intraoperative graft diameter for hamstring autograft ACL reconstruction, although an integrated model has yet to be described. The aim of this study was to present such a predictive model for quadrupled semitendinosus (4-ST) and doubled semitendinosus-gracilis (4-STG) graft constructs combining anthropometry (height and weight) and preoperative measurements of tendon as predictors.MethodsACL reconstructions using 4-STG and 4-ST were retrospectively reviewed. The outlines of the semitendinosus and gracilis tendons were identified manually in the axial slice of a preoperative T2 weighted MRI using a region-of-interest tool. Regression analysis using intraoperative graft diameter as the dependent variable was performed with tendon cross-sectional area (XSA), gender and height as predictors.Results108 ACL reconstructions in 107 patients were examined, 75 of which were performed using the 4-STG construct, and 33 which employed the 4-ST construct. The mean graft diameter in the 4-ST group (8.6 ± 0.8 mm) was significantly (p < 0.001) greater than the 4-STG group (7.9 ± 0.7 mm). Female gender and 4-STG graft construct were associated with increased risk of graft diameter <8 mm. Predictive models of graft diameter were accurate to ±1 mm for both construct types.ConclusionsAn integrated method for assessing patient risk of producing a diminutive graft diameter and planning augmentation in select cases has been presented. The present findings describe a validated predictive model that builds on previous univariable analyses. Further investigation of larger samples, including factors associated with graft preparation, is required to improve model accuracy for routine clinical application.Level of evidenceIV, Retrospective Cohort Study

Combined Assessments of Patellar Tendon and Hamstring Tendon Parameters on Preoperative Magnetic Resonance Imaging Can Improve Predictability of Hamstring Tendon Autograft Diameter in the Setting of Anterior Cruciate Ligament Reconstruction

“…There is a growing body of literature attempting to use preoperative MRI to predict intraoperative HTA diameter. 16 , 19 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 Most of these studies have used ST and GT CSA measurements and correlated these relative to HTA diameter, with results ranging from weak ( r = 0.16) to strong ( r = 0.81), and often, the sum of ST and GT has been reported as showing the strongest correlation ( r values ranging from 0.42 to 0.93). 16 , 19 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 Our study found a moderate correlation with ST CSA ( r = 0.48) and combined ST-GT CSA ( r = 0.67) and a stronger correlation with GT CSA ( r = 0.71) in isolation.…”

“…However, considerable variability and heterogeneity have been reported for measurements of HTAs either individually or together, with most studies indicating a moderate correlation between MRI and intraoperative assessments. 16 , 19 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 Thus, there remains an overall lack of strong preoperative HTA diameter predictors. 33 …”

Anatomical Variability of Intercondylar Fossa Geometry in Patients Diagnosed with Primary Anterior Cruciate Ligament Rupture

“…These findings largely agree with previous papers that reported differences in notch characteristics between sexes (Charlton et al, ; Chandrashekar et al, ) as well as relationship to weight with respect to ACL‐injury risk (Whitney et al, ). Although height has been previously correlated with potential graft diameter in hamstring autograft reconstruction (An et al, ), its relationship to geometry of the fossa has not been previously reported. Similarly, significant interactions between age and sex, as well as weight and sex have not been previously reported.…”

Can Preoperative Magnetic Resonance Imaging Predict Intraoperative Autograft Size for Anterior Cruciate Ligament Reconstruction? A Systematic Review

“…1). [30][31][32][33][34][35][36][37][38][39][40][41][42][43] The κ value assessing interreviewer agreement was substantial for title, abstract, and full-text screens, with values of 0.845 (95% CI ¼ 0.82-0.86), 0.930 (95% CI ¼ 0.92-0.94), and 0.975 (95% CI ¼ 0.96-0.98), respectively.…”