Michael B DiCosmo, Alyssa M DiCosmo, Michael J DeSarno, Matthew G Geeslin, Andrew G Geeslin
{"title":"用轴估计方法测量胫骨后坡并不亚于已建立的近端解剖轴方法，两者都不同于基于皮质的测量。","authors":"Michael B DiCosmo, Alyssa M DiCosmo, Michael J DeSarno, Matthew G Geeslin, Andrew G Geeslin","doi":"10.1016/j.arthro.2025.06.036","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether simpler alternative methods, using a tangential line along the (1) posterior tibial cortex (Posterior cortical reference, PCR), (2) anterior tibial cortex (Anterior cortical reference, ACR), (3) axis estimate (AE) can yield PTS measurements comparable in reliability and reproducibility to the proximal anatomic axis (PAA) method.</p><p><strong>Methods: </strong>Retrospective review of patients aged 18-40 with lateral knee radiographs and MRI within 30 days for pain and suspected internal derangement (January 2018 to January 2022), lateral radiograph with ≥ 10 cm of tibia distal to the joint line, and an MRI demonstrating no cruciate ligament tear (NT), ACL tear (ACLT) or PCL tear (PCLT). Each measurement was performed by two independent raters. Inter-method, inter- and intra-rater reliability were assessed using intraclass correlation (ICC).</p><p><strong>Results: </strong>155 patients met study criteria: 73 NT, 70 ACLT, and 12 PCLT. Compared to the PAA, the AE showed no difference (10.3°, p = 0.09), while the ACR (11.7°, p < 0.0001) and PCR (7.5°, p < 0.0001) differed significantly from the PAA. All methods had moderate reliability (ICCs 0.5-0.74). Intermethod ICC was excellent for the AE and PAA (ICC = 0.87), lowest for the PAA and PCR (ICC = 0.47).</p><p><strong>Conclusion: </strong>The reliability of the AE method was not significantly different from the established standard PAA method, and may serve as a suitable substitute in the clinical setting. The ACR and PCR methods were significantly different from the PAA. While the PAA and PCR method had similar inter-rater reliability it may underestimate the PTS and therefore may not be interchangeable with the PAA method.</p><p><strong>Clinical relevance: </strong>The PAA requires several steps to measure the PTS which can be time-consuming and prone to variability. A simpler and equally reliable method like the AE may increase utilization and maintain performance.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Posterior tibial slope measurement with the axis estimate method is not inferior to the established proximal anatomic axis method and both differ from cortical-based measurements.\",\"authors\":\"Michael B DiCosmo, Alyssa M DiCosmo, Michael J DeSarno, Matthew G Geeslin, Andrew G Geeslin\",\"doi\":\"10.1016/j.arthro.2025.06.036\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To evaluate whether simpler alternative methods, using a tangential line along the (1) posterior tibial cortex (Posterior cortical reference, PCR), (2) anterior tibial cortex (Anterior cortical reference, ACR), (3) axis estimate (AE) can yield PTS measurements comparable in reliability and reproducibility to the proximal anatomic axis (PAA) method.</p><p><strong>Methods: </strong>Retrospective review of patients aged 18-40 with lateral knee radiographs and MRI within 30 days for pain and suspected internal derangement (January 2018 to January 2022), lateral radiograph with ≥ 10 cm of tibia distal to the joint line, and an MRI demonstrating no cruciate ligament tear (NT), ACL tear (ACLT) or PCL tear (PCLT). Each measurement was performed by two independent raters. Inter-method, inter- and intra-rater reliability were assessed using intraclass correlation (ICC).</p><p><strong>Results: </strong>155 patients met study criteria: 73 NT, 70 ACLT, and 12 PCLT. Compared to the PAA, the AE showed no difference (10.3°, p = 0.09), while the ACR (11.7°, p < 0.0001) and PCR (7.5°, p < 0.0001) differed significantly from the PAA. All methods had moderate reliability (ICCs 0.5-0.74). Intermethod ICC was excellent for the AE and PAA (ICC = 0.87), lowest for the PAA and PCR (ICC = 0.47).</p><p><strong>Conclusion: </strong>The reliability of the AE method was not significantly different from the established standard PAA method, and may serve as a suitable substitute in the clinical setting. The ACR and PCR methods were significantly different from the PAA. While the PAA and PCR method had similar inter-rater reliability it may underestimate the PTS and therefore may not be interchangeable with the PAA method.</p><p><strong>Clinical relevance: </strong>The PAA requires several steps to measure the PTS which can be time-consuming and prone to variability. A simpler and equally reliable method like the AE may increase utilization and maintain performance.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-07-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2025.06.036\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2025.06.036","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Posterior tibial slope measurement with the axis estimate method is not inferior to the established proximal anatomic axis method and both differ from cortical-based measurements.
Purpose: To evaluate whether simpler alternative methods, using a tangential line along the (1) posterior tibial cortex (Posterior cortical reference, PCR), (2) anterior tibial cortex (Anterior cortical reference, ACR), (3) axis estimate (AE) can yield PTS measurements comparable in reliability and reproducibility to the proximal anatomic axis (PAA) method.
Methods: Retrospective review of patients aged 18-40 with lateral knee radiographs and MRI within 30 days for pain and suspected internal derangement (January 2018 to January 2022), lateral radiograph with ≥ 10 cm of tibia distal to the joint line, and an MRI demonstrating no cruciate ligament tear (NT), ACL tear (ACLT) or PCL tear (PCLT). Each measurement was performed by two independent raters. Inter-method, inter- and intra-rater reliability were assessed using intraclass correlation (ICC).
Results: 155 patients met study criteria: 73 NT, 70 ACLT, and 12 PCLT. Compared to the PAA, the AE showed no difference (10.3°, p = 0.09), while the ACR (11.7°, p < 0.0001) and PCR (7.5°, p < 0.0001) differed significantly from the PAA. All methods had moderate reliability (ICCs 0.5-0.74). Intermethod ICC was excellent for the AE and PAA (ICC = 0.87), lowest for the PAA and PCR (ICC = 0.47).
Conclusion: The reliability of the AE method was not significantly different from the established standard PAA method, and may serve as a suitable substitute in the clinical setting. The ACR and PCR methods were significantly different from the PAA. While the PAA and PCR method had similar inter-rater reliability it may underestimate the PTS and therefore may not be interchangeable with the PAA method.
Clinical relevance: The PAA requires several steps to measure the PTS which can be time-consuming and prone to variability. A simpler and equally reliable method like the AE may increase utilization and maintain performance.
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Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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