CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study

[EN] Purpose: The aim of this study was (1) to investigate the accuracy of identifying the femoral and tibial anterior cruciate ligament (ACL) footprints (FPs) using the Compressed Lateral and Anteroposterior Anatomical Systematic Sequences (CLASS) method compared to the to the gold standard (anatom...

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Autores: Thurig, Gregoire, Barrera Uso, Marc, PANADERO-MORALES, R., Joao Matos, Michael, Schwab, Joseph M., Tannast, Moritz, Petek, Daniel
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Universitat Politècnica de València (UPV)
Repositorio:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
Idioma:inglés
OAI Identifier:oai:riunet.upv.es:10251/233257
Acceso en línea:https://riunet.upv.es/handle/10251/233257
Access Level:acceso abierto
Palabra clave:ACL
CLASS
Femoral footprint
MRI
Tibial footprint
Tunnel placement
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spelling CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric studyThurig, GregoireBarrera Uso, MarcPANADERO-MORALES, R.Joao Matos, MichaelSchwab, Joseph M.Tannast, MoritzPetek, DanielACLCLASSFemoral footprintMRITibial footprintTunnel placement[EN] Purpose: The aim of this study was (1) to investigate the accuracy of identifying the femoral and tibial anterior cruciate ligament (ACL) footprints (FPs) using the Compressed Lateral and Anteroposterior Anatomical Systematic Sequences (CLASS) method compared to the to the gold standard (anatomical dissection with direct FP marking, referred to as aCLASS); (2) to determine whether the planned CLASS corresponds to the fluoroscopic imaging used during surgery and (3) to determine whether the position of the C-arm matters. Hypothesis: Planned CLASS (pCLASS) accurately corresponds to anatomical CLASS (aCLASS) and to intraoperative fluoroscopy, with superior accuracy using contralateral C-arm positioning. Method: Ten cadaveric knees were used in this study. A magnetic resonance imaging (MRI) scan was obtained of the native and dissected knee. MRI images of the dissected knee with marked femoral and tibial ACL FPs were used to create the aCLASS. Additionally, the native MRI was used to identify the ACL FP to simulate preoperative planning and generate the pCLASS. True-lateral fluoroscopic images with the image receptor contralaterally and ipsilaterally positioned were obtained. Statistical tests included the Friedman test for positional comparison across all groups. One-way analysis of variance (ANOVA) with Bonferroni adjustment and paired two-way t test was conducted for clinically relevant groups, with p < 0.05 set as the level of statistical significance. Results: No significant differences were found among aCLASS, pCLASS, contralateral and ipsilateral measurements for femoral high-low (p = 0.753), femoral deep-shallow (p = 0.197) and tibial anterior-posterior (p = 0.106). ANOVA and paired t tests confirmed no significant difference between pCLASS and both fluoroscopic positions (all p > 0.05). Conclusion: The CLASS method demonstrated no significant difference in FP localization compared with anatomic reference. This study validates CLASS as a reliable, patient-specific method for ACL FP identification that translates from preoperative MRI to intraoperative fluoroscopy regardless of whether the C-arm is positioned ipsilaterally or contralaterally. CLASS standardizes anatomical ACL reconstruction across diverse operative settings and surgeon experience levels.Springer-VerlagRepositorio Institucional de la Universitat Politècnica de València Riunet20262026-01-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://riunet.upv.es/handle/10251/233257reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valénciainstname:Universitat Politècnica de València (UPV)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Reconocimiento (by)http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:riunet.upv.es:10251/2332572026-06-13T07:49:27Z
dc.title.none.fl_str_mv CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
title CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
spellingShingle CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
Thurig, Gregoire
ACL
CLASS
Femoral footprint
MRI
Tibial footprint
Tunnel placement
title_short CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
title_full CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
title_fullStr CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
title_full_unstemmed CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
title_sort CLASS-MRI validates patient-specific ACL footprints across variable fluoroscopic C-arm positioning: A cadaveric study
dc.creator.none.fl_str_mv Thurig, Gregoire
Barrera Uso, Marc
PANADERO-MORALES, R.
Joao Matos, Michael
Schwab, Joseph M.
Tannast, Moritz
Petek, Daniel
author Thurig, Gregoire
author_facet Thurig, Gregoire
Barrera Uso, Marc
PANADERO-MORALES, R.
Joao Matos, Michael
Schwab, Joseph M.
Tannast, Moritz
Petek, Daniel
author_role author
author2 Barrera Uso, Marc
PANADERO-MORALES, R.
Joao Matos, Michael
Schwab, Joseph M.
Tannast, Moritz
Petek, Daniel
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositorio Institucional de la Universitat Politècnica de València Riunet
dc.subject.none.fl_str_mv ACL
CLASS
Femoral footprint
MRI
Tibial footprint
Tunnel placement
topic ACL
CLASS
Femoral footprint
MRI
Tibial footprint
Tunnel placement
description [EN] Purpose: The aim of this study was (1) to investigate the accuracy of identifying the femoral and tibial anterior cruciate ligament (ACL) footprints (FPs) using the Compressed Lateral and Anteroposterior Anatomical Systematic Sequences (CLASS) method compared to the to the gold standard (anatomical dissection with direct FP marking, referred to as aCLASS); (2) to determine whether the planned CLASS corresponds to the fluoroscopic imaging used during surgery and (3) to determine whether the position of the C-arm matters. Hypothesis: Planned CLASS (pCLASS) accurately corresponds to anatomical CLASS (aCLASS) and to intraoperative fluoroscopy, with superior accuracy using contralateral C-arm positioning. Method: Ten cadaveric knees were used in this study. A magnetic resonance imaging (MRI) scan was obtained of the native and dissected knee. MRI images of the dissected knee with marked femoral and tibial ACL FPs were used to create the aCLASS. Additionally, the native MRI was used to identify the ACL FP to simulate preoperative planning and generate the pCLASS. True-lateral fluoroscopic images with the image receptor contralaterally and ipsilaterally positioned were obtained. Statistical tests included the Friedman test for positional comparison across all groups. One-way analysis of variance (ANOVA) with Bonferroni adjustment and paired two-way t test was conducted for clinically relevant groups, with p < 0.05 set as the level of statistical significance. Results: No significant differences were found among aCLASS, pCLASS, contralateral and ipsilateral measurements for femoral high-low (p = 0.753), femoral deep-shallow (p = 0.197) and tibial anterior-posterior (p = 0.106). ANOVA and paired t tests confirmed no significant difference between pCLASS and both fluoroscopic positions (all p > 0.05). Conclusion: The CLASS method demonstrated no significant difference in FP localization compared with anatomic reference. This study validates CLASS as a reliable, patient-specific method for ACL FP identification that translates from preoperative MRI to intraoperative fluoroscopy regardless of whether the C-arm is positioned ipsilaterally or contralaterally. CLASS standardizes anatomical ACL reconstruction across diverse operative settings and surgeon experience levels.
publishDate 2026
dc.date.none.fl_str_mv 2026
2026-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://riunet.upv.es/handle/10251/233257
url https://riunet.upv.es/handle/10251/233257
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento (by)
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento (by)
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Springer-Verlag
publisher.none.fl_str_mv Springer-Verlag
dc.source.none.fl_str_mv reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
instname:Universitat Politècnica de València (UPV)
instname_str Universitat Politècnica de València (UPV)
reponame_str RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
collection RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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