Is Radiographic Measurement of Bony Landmarks Reliable for Lateral Meniscal Sizing?

Abstract

Background: The accuracy of meniscal measurement methods is still in debate.

Hypothesis: The authors’ protocol for radiologic measurements will provide reproducible bony landmarks, and this measurement method of the lateral tibial plateau will correlate with the actual anatomic value.

Study Design: Controlled laboratory study.

Methods: Twenty-five samples of fresh lateral meniscus with attached proximal tibia were obtained during total knee arthroplasty. Each sample was obtained without damage to the meniscus and bony attachment sites. The inclusion criterion was mild to moderate osteoarthritis in patients with mechanical axis deviation of less than 15°. Knees with lateral compartment osteoarthritic change or injured or degenerated menisci were excluded. For the lateral tibial plateau length measurements, the radiographic beam was angled 10° caudally at neutral rotation, which allowed differentiation of the lateral plateau cortical margins from the medial plateau. The transition points were identified and used for length measurement. The values of length were then compared with the conventional Pollard method and the anatomic values. The width measurement was done according to Pollard’s protocol. For each knee, the percentage deviation from the anatomic dimension was recorded. Intraobserver error and interobserver error were calculated.

Results: The deviation of the authors’ radiographic length measurements from anatomic dimensions was 1.4 ± 1.1 mm. The deviation of Pollard’s radiographic length measurements was 4.1 ± 2.0 mm. With respect to accuracy—which represents the frequency of measurements that fall within 10% of measurements—the accuracy of authors’ length was 98%, whereas for Pollard’s method it was 40%. There was a good correlation between anatomic meniscal dimensions and each radiologic plateau dimensions for lateral meniscal width (R² = .790) and the authors’ lateral meniscal length (R² = .823) and fair correlation for Pollard’s lateral meniscal length (R² = .660). The reliability of each radiologic measurement showed good reliability (intraclass correlation coefficients, .823 to .973). The authors tried to determine the best-fit equation for predicting meniscal size from Pollard’s method of bone size, as follows: anatomic length = 0.52 × plateau length (according to Pollard’s method) + 5.2, not as Pollard suggested (0.7 × Pollard’s plateau length). Based on this equation—namely, the modified Pollard method—the percentage difference decreased, and the accuracy increased to 92%.

Conclusion: Lateral meniscal length dimension can be accurately predicted from the authors’ radiographic tibial plateau measurements.

Clinical Relevance: This study may provide valuable information in preoperative sizing of lateral meniscus in meniscal allograft transplantation.