Patellar tendon graft position after anterior cruciate ligament reconstruction - Interobserver variability on lateral radiographs

We compared the reliability and validity of graft position measurements made by 4 orthopedic surgeons on intraoperative radiographs obtained using fluoroscopic control and postoperative radiographs obtained from the same 17 patients 6 weeks after ACL reconstruction. Measurements from postoperative radiographs varied significantly more than those from intraoperative radiographs. There was little agreement between the postoperative and intraoperative measurements of the tibial and femoral graft position. We conclude that postoperative radiographs are not a sufficient tool for assessing graft placement after ACL reconstruction using patellar tendon autografts. In order to consider graft position in follow-up studies and to compare results from various surgeons, we suggest intraoperative fluoroscopy to produce radiographs for accurate and reliable measurements.