Time to get rid of the clock: intraobserver and interobserver reliability in determination of the o'clock position of the femoral tunnel in ACL reconstruction.

This study evaluates intraobserver and interobserver agreement in reporting the o'clock position of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction. Four PGY2 residents, four PGY5 residents, and four sports medicine orthopedic surgeons reported the o'clock position of the femoral ACL tunnel in 10 arthroscopic pictures on two occasions 3 months apart. Intraobserver agreement was determined using the intraobserver correlation coefficient (r > 0.576 for 0.05 significance level). Interobserver agreement between members of each group and between reviewer groups was evaluated with the intraclass correlation coefficient (ICC > 0.75 considered good agreement). Poor interobserver agreement was demonstrated between the attending and PGY2 groups (ICC = 0.1685), between the attending and PGY5 groups (ICC = 0.2982), and between the PGY5 and PGY2 groups (ICC = 0.267). Attending surgeons, PGY5s, and PGY2s demonstrated poor interobserver agreement amongst themselves (ICC = 0.2244, 0.471, and 0.0859, respectively). PGY2s and PGY5s demonstrated good intraobserver agreement, but attending surgeons demonstrated poor intraobserver agreement. Attending orthopedic surgeons and residents of different levels of training interpret the o'clock position of the femoral tunnel differently. Greater years of experience does not improve intraobserver or interobserver agreement on the o'clock position. The clock face terminology for femoral tunnel placement may not be a reliable descriptor for scientific investigations or clinical instruction.

Distal femoral locking plates and the posterolateral corner.

The purpose of this study was to evaluate the effect of minimally invasive submuscular placement of a distal femoral locking plate on the posterolateral structures of the knee. Eight fresh-frozen cadaveric knees were dissected after application of a lateral distal femoral locking plate through a minimally invasive submuscular approach. The lateral collateral ligament and popliteus tendon were identified and inspected for injury. Distances from the plate to the lateral collateral ligament and popliteus insertions were determined.Neither the lateral collateral ligament nor the popliteus tendon was disrupted by the minimally invasive submuscular application of distal femoral periarticular locking plates. The mean distances to the lateral collateral ligament and popliteus tendon insertions were 2.5 and 6.6 mm, respectively.Distal femoral locking plates can be applied in a minimally invasive manner without disrupting the posterolateral structures of the knee.