ABSTRACT
BACKGROUND: Due to it being tangential to the distal femoral axis, the anteromedial portal presents significant risk of causing iatrogenic damage, and of producing tunnels that are too short for optimal osseointegration. Flexible reamers were developed to eliminate the need for knee hyperflexion and offer better-controlled orientation of the femoral tunnel. We aimed to compare the anteversion and length of femoral tunnels drilled using flexible reamers to those drilled using rigid reamers. METHODS: Between May 2012 and December 2013, all patients receiving ACL reconstruction performed by one surgeon were operated on using either a rigid or a flexible reamer from the same supplier (Versi-Tomic® system, Stryker, Kalamazoo, Michigan). The height of each patient was recorded, and the length and anteversion of the femoral tunnels were measured intra-operatively and on true lateral radiographs, respectively. RESULTS: Thirty-seven patients underwent operations using the rigid instrumentation, and 43 using the flexible instrumentation. There was no statistically significant difference between the two groups in either sex or height (p = n.s.). The patients operated on using the rigid instrumentation had tunnels anteverted by 18.6° ± 6° and 33.6 ± 2.9 mm long. Those operated on using the flexible instrumentation had tunnels anteverted by 40° ± 2° and 41.1 ± 3.57 mm long. Both anteversion and tunnel length were significantly greater for tunnels drilled using the flexible instrumentation (p < 0.001). CONCLUSIONS: This study demonstrated that flexible reamers produce significantly more anteverted and longer femoral tunnels during ACL reconstruction than rigid reamers. Clinical studies remain necessary to assess the outcomes of ACL reconstruction using flexible reamers.
ABSTRACT
OBJECTIVES: To evaluate the impact of Adaptive Iterative Dose Reduction (AIDR) on image quality and radiation dose in phantom and patient studies. METHODS: A phantom was examined in volumetric mode on a 320-detector CT at different tube currents from 25 to 550 mAs. CT images were reconstructed with AIDR and with Filtered Back Projection (FBP) reconstruction algorithm. Image noise, Contrast-to-Noise Ratio (CNR), Signal-to-Noise Ratio (SNR) and spatial resolution were compared between FBP and AIDR images. AIDR was then tested on 15 CT examinations of the lumbar spine in a prospective study. Again, FBP and AIDR images were compared. Image noise and SNR were analysed using a Wilcoxon signed-rank test. RESULTS: In the phantom, spatial resolution assessment showed no significant difference between FBP and AIDR reconstructions. Image noise was lower with AIDR than with FBP images with a mean reduction of 40%. CNR and SNR were also improved with AIDR. In patients, quantitative and subjective evaluation showed that image noise was significantly lower with AIDR than with FBP. SNR was also greater with AIDR than with FBP. CONCLUSION: Compared to traditional FBP reconstruction techniques, AIDR significantly improves image quality and has the potential to decrease radiation dose. KEY POINTS: This study showed that Adaptive Iterative Dose Reduction (AIDR) reduces image noise. In a phantom image noise was reduced without altering spatial resolution. In patients AIDR reduced the image noise in lumbar spine CT. AIDR can potentially reduce the dose for lumbar spine CT by 52%.