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Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to introduce a novel standardized algorithm using SPECT/CT, which promises the potential combined assessment of the biology of the joint in particular the bone-graft-fixation complex and the 3D tunnel placement in patients after ACL reconstruction. Its clinical application and inter- and intra-observer reliability should be critically evaluated.

Methods

A novel SPECT/CT localization scheme consisting of 13 tibial, 9 femoral and 4 patellar regions on standardized axial, coronal and sagittal slices is proposed. The tracer activity on SPECT/CT was localized and recorded in 25 consecutive patients using a 3D volumetric and quantitative analysis software. The inter- and intra-observer reliability was assessed for localization and tracer activity. The tunnel position was assessed in 3D-CT using standardized frames of reference. The inter- and intra-observer reliability (OR) of the measured distances were calculated (ICC).

Results

The localization scheme for tracer uptake analysis was useful and easily applicable in all 25 knees. It showed very high inter-OR and intra-ORs for all regions (ICC > 0.80). Tibial and femoral tunnel position measurements showed strong agreement between the readings of the two observers; the ICCs for the position, angulation, length and entry point of the femoral tunnel were >0.88 (intra-OR) and >0.86 (inter-OR). The ICC for the position of the tibial tunnel (angulation, length and entry point) was >0.79 (intra-OR) and >0.74 (inter-OR).

Conclusions

The SPECT/CT algorithm presented is highly reliable and clinically feasible. Combining the 3D-mechanical information on tunnel placement and attachment areas and the 3D metabolic data will be helpful in evaluating patients with pain after ACL reconstruction.

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Acknowledgments

We greatly thank the Deutsche Arthrose Hilfe e.V, Saarlouis, Germany as well as the Alwin-Jäger-Stiftung, Aschaffenburg, Germany for supporting our research and Jürg Schmutz, Bruderholz for his illustrative work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, 4101, Bruderholz, Switzerland

    Michael T. Hirschmann, Dominic Mathis, Faik K. Afifi, Niklaus F. Friederich & Markus P. Arnold

  2. Institute of Radiology and Nuclear Medicine, Kantonsspital Bruderholz, 4101, Bruderholz, Switzerland

    Helmut Rasch

  3. Imperial College London, London, UK

    Johann Henckel

  4. Amsler Consulting, Basel, Switzerland

    Felix Amsler

  5. OrthoImagingSolutions Ltd., London, UK

    Christopher R. Wagner

Authors
  1. Michael T. Hirschmann
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  2. Dominic Mathis
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  3. Faik K. Afifi
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  4. Helmut Rasch
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  5. Johann Henckel
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  6. Felix Amsler
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  7. Christopher R. Wagner
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  8. Niklaus F. Friederich
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  9. Markus P. Arnold
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Corresponding author

Correspondence to Michael T. Hirschmann.

Additional information

Michael T. Hirschmann and Dominic Mathis equally contribution to this work.

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Hirschmann, M.T., Mathis, D., Afifi, F.K. et al. Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc 21, 965–974 (2013). https://doi.org/10.1007/s00167-012-2083-6

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  • DOI: https://doi.org/10.1007/s00167-012-2083-6

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