Validation of a histologic scoring system for the examination of quality of tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction.

Pauline Po Yee Lui, Grace Ho, Yuk Wa Lee, Po Yan Ho, Wing Nin Lo, Chun Kwong Lo
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Abstract

Objective: To develop and validate a histologic scoring system for the assessment of tendon graft to bone tunnel healing in anterior cruciate ligament (ACL) reconstruction.

Study design: The scoring system, tendon-bone tunnel healing (TBTH) score, comprised 5 items on graft status,fiber type and interface connectivity, evaluated on either a 5- or 6-point scale. Two observers were trained to use the scoring system, examining 15 blinded histologic slides from an ongoing study. Afterward, an independent validation dataset consisting of 89 blinded histologic slides from the same study of different time points, tunnel positions and bone tunnels were scored for validity and reliability. Interrater and intrarater reliabilities were calculated. The sum was validated by the time-dependent change of healing.

Results: Both the intrarater and interrater reliabilities of the scoring system were high, with weighted K of 0.90-0.99 (all p < 0.001) and 0.84-0.94 (all p < 0.001), respectively, for different items. The sum of score increased significantly with time at different segments of both tunnels (all p < 0.05), consistent with the process of tunnel healing.

Conclusion: TBTH score is a reliable, valid measure for evaluating the histologic outcome of tendon graft to bone tunnel healing in ACL reconstruction.

检验前交叉韧带重建中肌腱移植物骨隧道愈合质量的组织学评分系统的验证。
目的:建立并验证前交叉韧带(ACL)重建中肌腱移植物骨隧道愈合的组织学评分系统。研究设计:评分系统,肌腱-骨隧道愈合(TBTH)评分,包括5个项目,包括移植物状态,纤维类型和界面连通性,以5或6分制进行评估。两名观察员接受了使用评分系统的训练,检查了一项正在进行的研究中的15张盲法组织学切片。随后,一个独立的验证数据集由来自同一研究的89个不同时间点、隧道位置和骨隧道的盲法组织学切片组成,对有效性和可靠性进行评分。计算了内部信度和内部信度。通过愈合随时间的变化来验证该数值。结果:评分系统的内部信度和内部信度均较高,不同项目的加权K值分别为0.90 ~ 0.99 (p < 0.001)和0.84 ~ 0.94 (p < 0.001)。两隧道不同段的积分总和均随时间增加而显著升高(p < 0.05),与隧道愈合过程一致。结论:TBTH评分是评价前交叉韧带重建中肌腱移植骨隧道愈合组织学结果的一种可靠、有效的方法。
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