Poster 173: Plain Radiographs and Three-Dimensional CT Imaging Are Highly Correlated for Coronal and Posterior Tibial Slope Measurements in Patients Undergoing Corrective Osteotomies
Notice bibliographique
Résumé
Objectives: Patient-specific instrumentation (PSI) based on three-dimensional (3D) computed tomography imaging (CT) is increasingly being used for corrective high tibial osteotomies (HTO’s) and distal femoral osteotomies (DFO’s). These PSI cutting guides are based off of measurements on a 3D CT, however plain radiographs are typically used during the pre-operative evaluation to determine the need for an osteotomy, and it is unclear how well measurements on plain radiographs correlate to those performed on 3D CT. The purpose of this study was to evaluate the correlation between measurements of coronal alignment and posterior tibial slope (PTS) on plain radiographs and measurements by semi-automated PSI software on 3D CT. It was hypothesized that coronal and posterior tibial slope measurements on plain radiographs would significantly correlate with measurements on 3D CT by PSI software. Methods: Patients who underwent hip to ankle CT as part of the pre-operative workup prior to a opening wedge (oW) or closing wedge (cW) HTO or DFO from October 2020 to November 2023 were reviewed. Mechanical medial tibial width ratio (mMTWr, Figure 1) and medial PTS (Figure 2) were evaluated pre-operatively by two independent raters, orthopaedic sports medicine fellows, on standing whole-leg radiographs and a lateral radiograph of the knee, respectively. Lateral radiographs were excluded if they were malrotated, defined as greater than 5 mm distance between the posterior aspect of the medial and lateral femoral condyles. The mMTWr and PTS using the full length tibial anatomic axis were measured on 3D CT utilizing semi-automated commercial PSI software (Bodycad, Quebec, Canada) without any surgeon involvement (Figure 3). Intra-class correlation coefficients were calculated to determine the inter-rater reliability between raters and between the raters and the PSI software for each measurement. Pearson’s correlation coefficient and an independent t-test were respectively used to analyze for a correlation and difference between the raters’ and PSI software’s measurements. Significance was set at p<0.05. Results: Complete data sets were obtained for 91 cases (43 oW-HTO, 17 cW-HTO, 24 oW-DFO, 4 cW-DFO, 1 rotational HTO, 1 combined cW-HTO and oW-DFO, 1 combined cW-HTO and cW-DFO). 11 patients were excluded from PTS measurements due to malrotated lateral knee radiographs. Demographics for the cohort are shown in Table 1. The ICC between raters for pre-operative mMTWr measurements was 0.99. The ICC between the raters’ measurements of mMTWr on whole-leg standing radiographs and the PSI measurements of mMTWr based on the 3D CT was 0.99, and these two measurements were significantly correlated (r=0.99, p<0.001). There was no difference between the raters’ (40.8% ± 23.5) and the PSI measurement of mMTWr (41.3% ± 22.1, p>0.05). The ICC’s between raters for pre-operative PTS measurements was 0.82. The ICC between the raters’ measurements of PTS on standard lateral knee radiographs and PSI measurements of medial PTS based on the 3D CT was 0.63, and these two measurements were significantly correlated (r=0.72, p<0.001). There was a significant difference between the raters’ measurements (10.4° ± 3.4) and the PSI measurements of PTS (12.0° ± 3.2, p<0.001). Conclusions: This study found that coronal measurements performed on standard whole-leg radiographs and by semi-automated PSI software on 3D CT and standing whole-leg radiographs are highly correlated with near perfect agreement between modalities. PTS measurements had moderate correlation between plain radiographs and 3D CT, and PTS on lateral knee radiographs was, on average, 1.6° less than 3D CT, which utilizes the full-length tibia. Although the absolute value of slope is different between modalities, these data are important as they confirm that PTS on plain radiographs is a moderately reproducible measurement which correlates highly with 3D CT. Altogether, these data confirm that measurements on standing whole-leg and lateral knee radiographs are reproducible and accurate for evaluating coronal alignment and PTS pre-operatively.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».