Determination of spatial position of tibial graft using X-ray images after anterior cruciate ligament reconstruction

Abstract

Background/Aim. Anterior cruciate ligament reconstruction is one of the most commonly performed knee surgeries in young adults. The success of this procedure largely depends on the proper formation of the tunnel, which is obtained by drilling the tibia and which serves to position and fix the graft. The aim of the study was to present a method for determining the spatial position of the graft based on only two standard X-rays. Methods. The study was performed on a group of 15 patients in whom the developed software applied the measurement of the angle of the tunnel in the tibia based on the selection of characteristic points on two standard X-rays of the knee (anterior-posterior and lateral projection). The obtained results were compared with the results of measuring the angle of the tunnel in the tibia on knee images by computed tomography (CT) in all patients. Results. The drilling angle measured in CT scans was, on average, some-what greater (59.07° ± 5.61°) than the angle measured by applying a developed application (58.65° ± 5.89°). The obtained results indicated minimal differences without statistical significance in the measurements of the angle of the tunnel in the tibia using the developed software and on CT images (Wilcoxon test: Z = -1.363; p = 0.173). Conclusion. The presented method and developed software are suitable for everyday clinical applications in terms of precision and usability and can be used to assess the position of tunnels in the tibia in the process of determining the success of surgery or in preparing patients for revision surgery.

Keywords

• anterior cruciate ligament reconstruction
• computer-aided design
• orthopedic procedures
• radiography
• tibia