Towards Standardization in the Diagnostic Evaluation of ACL Injuries in Skeletally Immature Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Delphi Panel
2.2. Delphi Structure and Data Collection
- What patient history questions are important to ask?
- What physical examination tests are important to perform?
- What (if any) radiographs do you obtain?
- What radiographic measurements (if any) do you make?
- What cross-sectional imaging studies (if any) do you obtain?
- What measurements (if any) do you make on cross-sectional imaging studies?
- What (if any) ancillary studies do you collect for these patients?
3. Results
3.1. Delphi Panelists
3.2. Consensus and Disagreement
3.2.1. Historical Factors
3.2.2. Physical Examination Factors
3.2.3. Radiographic Sequences
3.2.4. Radiographic Measurements
3.2.5. Cross-Sectional Imaging
3.2.6. Cross-Sectional Measurements
3.2.7. Ancillary Diagnostics
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Vignette | Modal Response | Agreement | Consensus | Disagreement Sources |
---|---|---|---|---|
9F | Injury History | 100 | 67% | |
Family History | 92 | |||
Sports Participation | 92 | |||
Current Symptoms | 100 | |||
10M | Injury History | 100 | 83% | |
Family History | 92 | |||
Sports Participation | 92 | |||
Current Symptoms | 100 | |||
12F | Injury History | 100 | 83% | Family History |
Sports Participation | 92 | |||
Current Symptoms | 100 | |||
Menarche | 100 | |||
13M | Family History | 92 | 83% | |
Sports Participation | 92 | |||
Current Symptoms | 100 | |||
Injury History | 100 |
Vignette | Modal Response | Agreement | Consensus | Disagreement Sources |
---|---|---|---|---|
9F | Lachmann | 100 | 67% | |
Pivot-shift | 100 | |||
Collateral exam | 100 | |||
Meniscal Exam | 100 | |||
ROM | 100 | |||
Ligamentous Laxity | 100 | |||
Effusion | 100 | |||
10M | Lachmann | 100 | 53% | |
Pivot-shift | 100 | |||
Collateral exam | 100 | |||
Meniscal Exam | 100 | |||
ROM | 100 | |||
Ligamentous Laxity | 100 | |||
Effusion | 100 | |||
12F | Lachmann | 100 | 75% | |
Pivot-shift | 100 | |||
Collateral exam | 100 | |||
Meniscal Exam | 100 | |||
ROM | 100 | |||
Ligamentous Laxity | 100 | |||
Effusion | 100 | |||
13M | Lachmann | 100 | 67% | Effusion |
Pivot-shift | 100 | |||
Collateral exam | 100 | |||
Meniscal Exam | 100 | |||
ROM | 100 | |||
Ligamentous Laxity | 100 |
Vignette | Modal Response | Agreement | Consensus | Disagreement Sources |
---|---|---|---|---|
(a) | ||||
9F | Flexion | 83 | 67% | |
Standing AP | 100 | |||
Lateral | 100 | |||
Long-leg Alignment | 92 | |||
Bone Age Wrist Films | 83 | |||
10M | Flexion | 83 | 67% | |
Standing AP | 100 | |||
Lateral | 100 | |||
Long-leg Alignment | 92 | |||
Bone Age Wrist Films | 83 | |||
12F | Flexion | 93 | 67% | |
Standing AP | 100 | |||
Lateral | 100 | |||
Long-leg Alignment | 92 | |||
Bone Age Wrist Films | 92 | |||
13M | Flexion | 83 | 67% | |
Standing AP | 100 | |||
Lateral | 100 | |||
Long-leg Alignment | 92 | |||
Bone Age Wrist Films | 92 | |||
(b) | ||||
9F | Tibial Slope | 100 | 67% | |
10M | Tibial Slope | 100 | 67% | Mechanical Axis Alignment |
Physeal Status | 100 | |||
12F | Tibial Slope | 100 | 75% | |
13M | Tibial Slope | 100 | 67% | Mechanical Axis Alignment |
Physeal Status | 100 |
Diagnostic Evaluation Technique | 9F | 10M | 12F | 13M | All |
---|---|---|---|---|---|
Patient History | |||||
Injury History | * | * | * | * | * |
Family History | * | * | # | * | * |
Sports Participation | * | * | * | * | * |
Current Symptoms | * | * | * | * | * |
Menarche | * | * | |||
Physical Exam | |||||
Lachmann | * | * | * | * | * |
Pivot-shift | * | * | * | * | * |
Collateral Exam | * | * | * | * | * |
Meniscal Exam | * | * | * | * | * |
ROM | * | * | * | * | * |
Ligamentous Laxity | * | * | * | * | * |
Effusion | * | * | * | * | |
Radiographic Sequence | |||||
Flexion | * | * | * | * | * |
Standing AP | * | * | * | * | * |
Lateral | * | * | * | * | * |
Long-leg Alignment | * | * | * | * | * |
Bone Age Wrist Films | * | * | * | * | * |
Radiographic Interpretation | |||||
Tibial Slope | * | * | * | * | * |
Physeal Status | * | * | * | ||
Mechanical alignment/leg lengths | # | # | # | # | * |
Skeletal age | # | # | # | # | * |
Cross-Sectional Imaging | |||||
MRI | * | * | * | * | * |
Cross-Sectional Measurement | |||||
None | * | * | * | * | * |
Ancillary Studies | |||||
None | * | * | * | * | * |
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Seabol, L.; Boden, S.; Herman, M.; Ruh, E.; Kocher, M.; McClincy, M. Towards Standardization in the Diagnostic Evaluation of ACL Injuries in Skeletally Immature Patients. Int. J. Environ. Res. Public Health 2021, 18, 2684. https://doi.org/10.3390/ijerph18052684
Seabol L, Boden S, Herman M, Ruh E, Kocher M, McClincy M. Towards Standardization in the Diagnostic Evaluation of ACL Injuries in Skeletally Immature Patients. International Journal of Environmental Research and Public Health. 2021; 18(5):2684. https://doi.org/10.3390/ijerph18052684
Chicago/Turabian StyleSeabol, Liliana, Stephanie Boden, Max Herman, Ethan Ruh, Mininder Kocher, and Michael McClincy. 2021. "Towards Standardization in the Diagnostic Evaluation of ACL Injuries in Skeletally Immature Patients" International Journal of Environmental Research and Public Health 18, no. 5: 2684. https://doi.org/10.3390/ijerph18052684