Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. METHODS: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. RESULTS: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. CONCLUSIONS: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories.

Acute treatment of inversion ankle sprains: immobilization versus functional treatment.

Inversion ankle sprains are one of the most common injuries in sports. Although these injuries are often considered minor, they can lead to persistent disability in athletes. We conducted a systematic review of the literature to evaluate the effect of immobilization versus early functional treatment on time to return to preinjury activity after inversion ankle sprain. Residual subjective instability, recurrent injury, and patient satisfaction were secondary outcomes. A systematic review identified 9 randomized controlled trials. Return to preinjury activity was less with early functional treatment in 4 of 5 studies that evaluated this outcome. Subjective instability was less in 3 of 5 studies. Similarly, reinjury rate was less in 5 of 6 studies. Patient satisfaction was not substantially different in the two studies that evaluated this outcome. Limitations of the identified trials included small sample size, heterogeneity of treatment methods, and lack of standardized outcome measures. However, based on our review the current best evidence suggests a trend favoring early functional treatment over immobilization for the treatment of acute lateral ankle sprains.

Navicular stress fractures.

Since the stress fracture of the tarsal navicular was first described in 1970, awareness of the injury has increased, and navicular stress fractures have represented up to 35% of stress fractures in recent series. However, these injuries remain difficult to diagnose and treat because of their often vague clinical presentation and the poor correlation between radiographic and clinical findings.