Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2014

01-09-2014 | Knee

Accuracy and reliability of determining the isometric point of the knee for multiligament knee reconstruction

Authors: Jeff R. S. Leiter, Bruce A. Levy, James P. Stannard, Gregory C. Fanelli, Daniel B. Whelan, Robert G. Marx, Michael J. Stuart, Joel L. Boyd, Peter B. MacDonald

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2014

Login to get access

Abstract

Purpose

To compare the accuracy and reliability of the anatomic and radiographic techniques for identifying the isometric point of the knee.

Methods

Only four specimens were used; however, eight experienced multiligament knee injury surgeons were recruited to address this limitation. Surgeons estimated the isometric point (EIP) on the medial and lateral sides using an anatomic and radiographic method. The x and y coordinates of the EIP were compared to the true isometric point (TIP). T-tests and interclass correlation coefficients (ICC) were performed to determine the accuracy and reliability between the methods.

Results

There was no difference in placement of the EIP on the medial side of the knee in the anterior/posterior (x; p = n.s.) and superior/inferior direction (y; p = n.s). The EIP was anterior (p = 0.001) to the TIP with the radiographic method on the lateral side and approached significance (p = 0.05) in the superior/inferior direction. The ICC (95 % CI) for identifying the EIP on the medial side in the anterior/posterior direction using the anatomic method was 0.64 (0.28–0.96) and 0.11 (−0.06 to 0.77) in the superior/inferior direction. Using the radiographic method, the ICC in the anterior/posterior and superior/inferior direction was 0.49 (0.14–0.94) and 0.15 (−0.47 to 0.81), respectively. On the lateral side, the ICC for the anatomic method was 0.84 (0.56–0.99) in the anterior/posterior direction and 0.36 (0.05–0.90) in the superior/inferior direction. Using the radiographic method, the ICC in the anterior/posterior and superior/inferior direction was 0.61 (0.26–0.96) and 0.89 (0.67–0.99), respectively.

Conclusions

There was no difference in accuracy on the medial side of the knee. On the lateral side, the anatomic method was more accurate in the anterior/posterior direction. Reliability was greater in the anterior/posterior direction on both sides of the knee. Surgeons were most likely to place the isometric point anterior and superior to the TIP on both the medial and lateral sides of the knee with either method which has the potential to cause graft lengthening. This should be taken into consideration during reconstruction/repair of the MCL/PMC and LCL/PLC.
Literature
1.
go back to reference Benjamin Jackson J III, Ferguson CM, Martin DF (2006) Surgical treatment of chronic posteromedial instability using capsular procedures. Sports Med Arthrosc 14:91–95PubMedCrossRef Benjamin Jackson J III, Ferguson CM, Martin DF (2006) Surgical treatment of chronic posteromedial instability using capsular procedures. Sports Med Arthrosc 14:91–95PubMedCrossRef
2.
go back to reference Brinkman J-M, Schwering PJA, Blankevoort L, Kooloos JG, Koolos JG, Luites J, Wymenga AB (2005) The insertion geometry of the posterolateral corner of the knee. J Bone Joint Surg Br 87:1364–1368PubMedCrossRef Brinkman J-M, Schwering PJA, Blankevoort L, Kooloos JG, Koolos JG, Luites J, Wymenga AB (2005) The insertion geometry of the posterolateral corner of the knee. J Bone Joint Surg Br 87:1364–1368PubMedCrossRef
3.
go back to reference Camarda L, Condello V, Madonna V, Cortese F, D’Arienzo M, Zorzi C (2010) Results of isolated posterolateral corner reconstruction. J Orthop Traumatol 11:73–79PubMedCentralPubMedCrossRef Camarda L, Condello V, Madonna V, Cortese F, D’Arienzo M, Zorzi C (2010) Results of isolated posterolateral corner reconstruction. J Orthop Traumatol 11:73–79PubMedCentralPubMedCrossRef
4.
go back to reference Fanelli GC (2000) Treatment of combined anterior cruciate ligament-posterior cruciate ligament-lateral side injuries of the knee. Clin Sports Med 19:493–502PubMedCrossRef Fanelli GC (2000) Treatment of combined anterior cruciate ligament-posterior cruciate ligament-lateral side injuries of the knee. Clin Sports Med 19:493–502PubMedCrossRef
5.
go back to reference Fanelli GC, Edson CJ (2004) Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 20:339–345PubMedCrossRef Fanelli GC, Edson CJ (2004) Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 20:339–345PubMedCrossRef
6.
go back to reference Fanelli GC, Harris JD (2006) Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc 14:78–83PubMedCrossRef Fanelli GC, Harris JD (2006) Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc 14:78–83PubMedCrossRef
7.
go back to reference Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17:1078–1082PubMedCentralPubMedCrossRef Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Isometry of medial collateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 17:1078–1082PubMedCentralPubMedCrossRef
8.
go back to reference Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 37:1123–1130PubMedCrossRef Feeley BT, Muller MS, Allen AA, Granchi CC, Pearle AD (2009) Biomechanical comparison of medial collateral ligament reconstructions using computer-assisted navigation. Am J Sports Med 37:1123–1130PubMedCrossRef
9.
go back to reference Feeley BT, Muller MS, Sherman S, Allen AA, Pearle AD (2010) Comparison of posterolateral corner reconstructions using computer-assisted navigation. Arthroscopy 26:1088–1095PubMedCrossRef Feeley BT, Muller MS, Sherman S, Allen AA, Pearle AD (2010) Comparison of posterolateral corner reconstructions using computer-assisted navigation. Arthroscopy 26:1088–1095PubMedCrossRef
10.
go back to reference Hoover NW (1961) Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin N Am 41:1099–1112PubMed Hoover NW (1961) Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin N Am 41:1099–1112PubMed
11.
go back to reference Jakobsen BW, Lund B, Christiansen SE, Lind MC (2010) Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients. Arthroscopy 26:918–925PubMedCrossRef Jakobsen BW, Lund B, Christiansen SE, Lind MC (2010) Anatomic reconstruction of the posterolateral corner of the knee: a case series with isolated reconstructions in 27 patients. Arthroscopy 26:918–925PubMedCrossRef
12.
go back to reference Jones RE, Smith EC, Bone GE (1979) Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet 149:554–558PubMed Jones RE, Smith EC, Bone GE (1979) Vascular and orthopedic complications of knee dislocation. Surg Gynecol Obstet 149:554–558PubMed
13.
go back to reference Kannus P, Järvinen M (1990) Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med 9:244–260PubMedCrossRef Kannus P, Järvinen M (1990) Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med 9:244–260PubMedCrossRef
14.
go back to reference Kim JG, Ha JG, Lee YS, Yang SJ, Jung JE, Oh SJ (2009) Posterolateral corner anatomy and its anatomical reconstruction with single fibula and double femoral sling method: anatomical study and surgical technique. Arch Orthop Trauma Surg 129:381–385PubMedCrossRef Kim JG, Ha JG, Lee YS, Yang SJ, Jung JE, Oh SJ (2009) Posterolateral corner anatomy and its anatomical reconstruction with single fibula and double femoral sling method: anatomical study and surgical technique. Arch Orthop Trauma Surg 129:381–385PubMedCrossRef
15.
go back to reference Kim S-J, Kim H-S, Moon H-K, Chang W-H, Kim S-G, Chun Y-M (2010) A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model. Arthroscopy 26:335–341PubMedCrossRef Kim S-J, Kim H-S, Moon H-K, Chang W-H, Kim S-G, Chun Y-M (2010) A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model. Arthroscopy 26:335–341PubMedCrossRef
16.
go back to reference LaPrade RF (2010) Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg 92:16PubMedCrossRef LaPrade RF (2010) Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg 92:16PubMedCrossRef
17.
go back to reference LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860PubMed LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31:854–860PubMed
18.
go back to reference Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38:804–809PubMedCrossRef Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38:804–809PubMedCrossRef
19.
go back to reference Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ (2009) Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 17:197–206PubMed Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ (2009) Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 17:197–206PubMed
20.
go back to reference Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37:1116–1122PubMedCrossRef Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE (2009) Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability. Am J Sports Med 37:1116–1122PubMedCrossRef
21.
go back to reference Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12:334–346PubMed Rihn JA, Groff YJ, Harner CD, Cha PS (2004) The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 12:334–346PubMed
22.
go back to reference Rios CG, Leger RR, Cote MP, Yang C, Arciero RA (2010) Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med 38:1564–1574PubMedCrossRef Rios CG, Leger RR, Cote MP, Yang C, Arciero RA (2010) Posterolateral corner reconstruction of the knee: evaluation of a technique with clinical outcomes and stress radiography. Am J Sports Med 38:1564–1574PubMedCrossRef
23.
go back to reference Robinson JR, Sanchez-Ballester J, Bull AMJ, de Thomas R, Amis AA (2004) The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 86:674–681PubMedCrossRef Robinson JR, Sanchez-Ballester J, Bull AMJ, de Thomas R, Amis AA (2004) The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 86:674–681PubMedCrossRef
24.
go back to reference Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG (2009) Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy 25:232–242PubMedCrossRef Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG (2009) Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy 25:232–242PubMedCrossRef
25.
go back to reference Shi S, Ying X-Z, Zheng Q, Cao G-P (2009) Isometric reconstruction of the posterolateral corner of the knee. Acta Orthop Belg 75:504–511PubMed Shi S, Ying X-Z, Zheng Q, Cao G-P (2009) Isometric reconstruction of the posterolateral corner of the knee. Acta Orthop Belg 75:504–511PubMed
26.
go back to reference Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610PubMedCrossRef Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6:593–610PubMedCrossRef
27.
go back to reference Stannard J, Clayton M, Tunmire D, Johnson C, Tubbs S, Moura C, Volgas D (2009) Determining isometric point for reconstruction of the corners. 28th Annual Meeting San Diego, CA Stannard J, Clayton M, Tunmire D, Johnson C, Tubbs S, Moura C, Volgas D (2009) Determining isometric point for reconstruction of the corners. 28th Annual Meeting San Diego, CA
28.
go back to reference Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33:881–888PubMedCrossRef Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33:881–888PubMedCrossRef
29.
go back to reference Stannard JP, Brown SL, Robinson JT, McGwin G Jr, Volgas DA (2005) Reconstruction of the posterolateral corner of the knee. Arthroscopy 21:1051–1059PubMedCrossRef Stannard JP, Brown SL, Robinson JT, McGwin G Jr, Volgas DA (2005) Reconstruction of the posterolateral corner of the knee. Arthroscopy 21:1051–1059PubMedCrossRef
30.
go back to reference Stannard JP, Hammond A, Tunmire D, Clayton M, Johnson C, Moura C (2012) Determining the isometric point of the knee. J Knee Surg 25:71–74PubMedCrossRef Stannard JP, Hammond A, Tunmire D, Clayton M, Johnson C, Moura C (2012) Determining the isometric point of the knee. J Knee Surg 25:71–74PubMedCrossRef
31.
go back to reference Taylor DC, Posner M, Curl WW, Feagin JA (2009) Isolated tears of the anterior cruciate ligament: over 30-year follow-up of patients treated with arthrotomy and primary repair. Am J Sports Med 37:65–71PubMedCrossRef Taylor DC, Posner M, Curl WW, Feagin JA (2009) Isolated tears of the anterior cruciate ligament: over 30-year follow-up of patients treated with arthrotomy and primary repair. Am J Sports Med 37:65–71PubMedCrossRef
32.
go back to reference Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363PubMed
33.
go back to reference Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61:56–62PubMed Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61:56–62PubMed
34.
go back to reference Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T (1993) Functional anatomy of the posterolateral structures of the knee. Arthroscopy 9:57–62PubMedCrossRef Watanabe Y, Moriya H, Takahashi K, Yamagata M, Sonoda M, Shimada Y, Tamaki T (1993) Functional anatomy of the posterolateral structures of the knee. Arthroscopy 9:57–62PubMedCrossRef
35.
go back to reference Zhou X, Chen Z, Liang J (2009) Reconstruction of posterolateral structure in knee with Müller method. Zhongguo Gu Shang 22:174–175PubMed Zhou X, Chen Z, Liang J (2009) Reconstruction of posterolateral structure in knee with Müller method. Zhongguo Gu Shang 22:174–175PubMed
Metadata
Title
Accuracy and reliability of determining the isometric point of the knee for multiligament knee reconstruction
Authors
Jeff R. S. Leiter
Bruce A. Levy
James P. Stannard
Gregory C. Fanelli
Daniel B. Whelan
Robert G. Marx
Michael J. Stuart
Joel L. Boyd
Peter B. MacDonald
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2661-2

Other articles of this Issue 9/2014

Knee Surgery, Sports Traumatology, Arthroscopy 9/2014 Go to the issue