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Inter-observer agreement in the identification of the two bundles of the anterior cruciate ligament using magnetic resonance imaging

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Abstract

Background

Magnetic resonance imaging has become the method of choice to diagnose meniscal and ligament lesions of the knee. New approaches to the surgical treatment of partial anterior cruciate ligament tears led us to try to distinguish the two bundles of that ligament with MRI and to evaluate inter-observer agreement in different viewing planes.

Methods

Images of 50 right and 50 left ligament-intact knees were examined in the coronal and axial viewing planes. Each sequence was independently read by a radiologist and a medical student to note, in each viewing plane, the number of images in which the two-bundle structure of the ligament was clearly seen. Cohen’s Kappa coefficients were used to determine inter-observer agreements.

Results

The percentage of sequences in which the two bundles were distinguished by the radiologist and the student on one image at least were 82 versus 73% in the coronal plane and 90 versus 93% in the axial plane, respectively. The average number of successive images with clear bundles was higher in the axial (2.7 vs. 1.7) than in the coronal plane (2.2 vs. 1). There was a poor inter-observer agreement in the coronal plane (k = 0.176) but an intermediate agreement in the axial plane (k = 0.385 or 0.522 depending on number pooling).

Conclusions

The axial viewing plane seems more favourable to distinguish the two bundles of the anterior cruciate ligament with the best possible reproducibility. An oblique-axial plane is deemed to insure a clearer diagnosis of partial tears.

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References

  1. Amis AA, Dawkins GPC (1991) Functional anatomy of the anterior cruciate ligament. J Bone Joint Surg 73(2):260–267

    CAS  Google Scholar 

  2. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:27–46

    Article  Google Scholar 

  3. Drapé JL, Godefroy D, Dupont AM, Chevrot A (1999) Radio-anatomie du genou. Encyclopédie Médico Chirurgicale 80(6 Suppl):628–639

    Google Scholar 

  4. Duc SR, Zanetti M, Kramer J, Kach KP, Zollikofer CL, Wentz KU (2005) Magnetic resonance imaging of the anterior cruciate ligament tears: evaluation of standard orthogonal and tailored paracoronal images. Acta Radiol 46(7):729–733

    Article  PubMed  CAS  Google Scholar 

  5. Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Menetrey J (2006) Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:204–213

    Article  PubMed  CAS  Google Scholar 

  6. Giris FG, Marshall JL, Al Monajem ARS (1975) The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231

    Article  Google Scholar 

  7. Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256

    Article  PubMed  Google Scholar 

  8. Hollis JM, Takai S, Adam DJ, Horibe S, Woo SL (1991) The effects of knee motion and external loading on the length of the anterior cruciate ligament (ACL): a kinematic study. J Biomech Eng 113:208–214

    Article  PubMed  CAS  Google Scholar 

  9. Hong SH, Choi JY, Lee GK, Choi JA, Chung HW, Kang HS (2003) Grading of anterior cruciate ligament injury. Diagnostic efficacy of oblique coronal magnetic resonance imaging of the knee. J Comput Assist Tomogr 27(5):814–819

    Article  PubMed  Google Scholar 

  10. Katahira K, Yamashita Y, Takahashi M et al (2001) MR imaging of the anterior cruciate ligament: value of thin slice direct oblique coronal technique. Radiat Med 19(1):1–7

    PubMed  CAS  Google Scholar 

  11. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  12. Lee JK, Yao L, Phelps CT, Writh CR, Czajka J, Lozman J (1988) Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 166:861–864

    PubMed  CAS  Google Scholar 

  13. Lerman JE, Gray DS, Schweitzer ME, Bartolozzi A (1995) MR evaluation of the anterior cruciate ligament: value of axial images. J Comput Assist Tomogr 19(4):604–607

    Article  PubMed  CAS  Google Scholar 

  14. Mellado JM, Calmet J, Olona M, Gine J, Saturi A (2004) Magnetic resonance imaging of anterior cruciate ligament: reevaluation of quantative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle. Knee Surg Sports Traumatol Arthrosc 12(3):217–224

    Article  PubMed  CAS  Google Scholar 

  15. Odensten M, Gillquist J (1985) Functionnal anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262

    PubMed  CAS  Google Scholar 

  16. Polly DW Jr, Callaghan JJ, Sikes RA, McCabe JM, McMahon K, Savory CG (1988) The accuracy of selective magnetic resonance imaging compared with the findings of arthtroscopy of the knee. J Bone Joint Surg Am 70:192–197

    PubMed  Google Scholar 

  17. Reicher MA, Rauschning W, Gold RH (1985) High-resolution magnetic resonance imaging of the knee joint: normal anatomy. Am J Roentgenol 145:895–902

    CAS  Google Scholar 

  18. Starman JS, VanBeek C, Armfield DR, Sahasrabudhe A, Baker CLIII, Irrgang JJ, Fu FH (2007) Assessment of normal ACL double anatomy in standard viewing planes by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 167(6):266–268

    Google Scholar 

  19. Steckel H, Vadala G, Davis D, Fu FH (2006) 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc 14:1151–1158

    Article  PubMed  Google Scholar 

  20. Turner DA, Prodromos CC, Petasnik JP, Clark JW (1985) Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 154(4):717–722

    PubMed  CAS  Google Scholar 

  21. Umans H, Wimpfheimer O, Haramati N, Applbaum YH, Adler M, Bosco J (1995) Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. Am J Roentgenol 165(4):893–897

    CAS  Google Scholar 

  22. Vaz CES, de Camargo OP, de Santana PJ, Valei AC (2005) Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions. Clinics 60(6):445–450

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Dr. Payet Barry, internist, Centre Hospitalier de Roanne, and Dr. Jean Iwaz, scientific advisor, Hospices Civils de Lyon, for review and editing of the manuscript.

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Authors and Affiliations

  1. Laboratoire d’Anatomie de Rockefeller, Université Claude Bernard Lyon 1, 69312, Lyon Cedex 08, France

    M. Montoy & F. Cotton

  2. Service de Radiologie et IRM, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite, France

    T. Euvrard & F. Cotton

  3. Service de Chirurgie Orthopédique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69495, Pierre-Bénite, France

    B. Moyen & J. C. Rollier

  4. Service de Biostatistique, Hospices Civils de Lyon, 69424, Lyon, France

    P. Roy

  5. Université de Lyon, Université Lyon I, 69622, Villeurbanne, France

    P. Roy

  6. Laboratoire Biostatistique Santé, CNRS, UMR 5558, 69495, Pierre-Bénite, France

    P. Roy

  7. CREATIS, INSA-502, 69621, Villeurbanne, France

    F. Cotton

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  1. M. Montoy
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  2. T. Euvrard
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  5. J. C. Rollier
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  6. F. Cotton
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Correspondence to F. Cotton.

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Montoy, M., Euvrard, T., Moyen, B. et al. Inter-observer agreement in the identification of the two bundles of the anterior cruciate ligament using magnetic resonance imaging. Surg Radiol Anat 30, 557–562 (2008). https://doi.org/10.1007/s00276-008-0370-1

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  • DOI: https://doi.org/10.1007/s00276-008-0370-1

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