A Prospective Evaluation of Femoral Tunnel Placement for Anatomic Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Magnetic Resonance Imaging

Hart, Adam; Sivakumaran, Thiru; Burman, Mark; Powell, T.; Martineau, Paul A.

doi:10.1177/0363546517730577

Cited by 30 publications

(49 citation statements)

References 64 publications

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“…Similarly, the accuracy of surgical placement is seen to vary about a planned point. In a study by Hart et al, four different "anatomical" techniques were compared with a mean error in placement of 3-4 mm with each method [20]. Thus, there is variation in both anatomy and surgical accuracy (both in the region of 4 mm) equating to combined errors that may be relatively large (8 mm).…”

Section: Discussionmentioning

confidence: 99%

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Kosy

Walmsley

Sharma

et al. 2020

Knee Surg & Relat Res

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Background: Graft malposition is a risk factor for failure of anterior cruciate ligament reconstruction. A 70°a rthroscope improves visualisation of the medial wall of the lateral femoral condyle without switching portals. We investigated whether the use of this arthroscope affected the accuracy and precision of femoral tunnel placement. Methods: Fifty consecutive adult patients were recruited. Following one withdrawal and two exclusions, 47 patients (30 in group 1 (70°arthroscope), 17 in group 2 (30°arthroscope)) underwent three-dimensional computed tomography imaging using a grid-based system to measure tunnel position. Results: No difference was found in the accuracy or precision of tunnels (mean position: group 1 = 33.3 ± 6.0% deep-shallow, 27.2 ± 5.2% high-low; group 2 = 31.7 ± 6.9% deep-shallow, 29.0 ± 6.2% high-low; not significant). A post-hoc power analysis suggests a study of 106 patients would be required. Conclusions: This pilot study suggests that tunnel position is not affected by the arthroscope used. An appropriately powered study could investigate this finding alongside other potential benefits of using a 70°a rthroscope for this procedure.

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Section: Discussionmentioning

confidence: 99%

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Kosy

Walmsley

Sharma

et al. 2020

Knee Surg & Relat Res

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“…The imaging protocol for this study was a previously validated isotropic 3D MRI protocol. 19,21,27 Both 2D and 3D MRI scans were performed by use of the same 1.5-T Twin-Speed Excite high-definition MRI scanner (GE Medical Systems). In the scanner, the knees were positioned in near full extension, and an 8-channel high-definition surface coil was applied.…”

Section: Study Protocolmentioning

confidence: 99%

“…The 3D MRI entailed an oblique-coronal proton density sequence along the plane of the ACL with slice gaps of 0.6 mm. 19,21…”

Section: Study Protocolmentioning

confidence: 99%

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Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling

Laverdière

Harvey

Schupbach

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) is an intricate procedure that requires highly specific surgical skills. Purpose: To report the ability of residents to identify femoral landmarks and the native ACL footprint before and after a structured formal teaching session as a reflection of overall surgical skill training for orthopaedic surgery residents in Canada. Study Design: Controlled laboratory study. Methods: A total of 13 senior orthopaedic residents were asked to identify a femoral landmark and an ACL footprint on ten 3-dimensional (3D)–printed knee models before and after a teaching session during the fall of 2018. The 3D models were made based on actual patients with different anatomic morphologic features. ImageJ software was used to quantify the measurements, which were then analyzed through use of descriptive statistics. Results: Before and after the teaching session, residents attempted to identify a specific anatomic location (bifurcate and intercondylar ridge intersection) with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to 12.13 mm in magnitude, respectively. Furthermore, before and after the teaching session, residents identified the specific position to perform the surgical procedure (ACL femoral footprint), with a mean error per participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude, respectively. The teaching session resulted in no significant improvement in identification of either the intersection of the bifurcate and intercondylar ridges ( P = .9343 in the proximal-distal axis and P = .8133 in the anteroposterior axis) or the center of the femoral footprint ( P = .7761 in the proximal-distal axis and P = .9742 in the anteroposterior axis). Conclusion: Although a formal teaching session was combined with a hands-on session that entailed real surgical instrumentation and fresh cadaveric specimens, the intervention seemed to have no direct impact on senior residents’ performance or their ability to demonstrate the material taught. This puts into question the format and efficacy of present teaching methods. Also, it is possible that the 3D spatial perception required to perform these skills is not something that can be taught effectively through a teaching session or at all. Further investigation is required regarding the effectiveness and application of surgical skill laboratories and simulations on the competencies of orthopaedic residents.

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“…Type 2 patients, for example, to better ascertain how an OTT revision compares to two-stage revision ACL procedures). Additional efforts will also aim to assess feasibility across other diagnostic modalities, such as MRI, 3D-MRI, 51 arthroscopic examination videos, and 3D printed models. This will be important going forward to ascertain the need for CT in this classification based on its performance with other modalities, given the risks of radiation.…”

Section: Limitationsmentioning

confidence: 99%

The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification

Crum

Rabuck

et al. 2019

J Knee Surg

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Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REVision using Imaging to guide Staging and Evaluation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and practical with acceptable inter-rater agreement. A focus group of sports medicine fellowship-trained orthopaedic surgeons was assembled to develop a classification to assess femoral/tibial tunnel “usability” (placement, widening, overlap) and guide the revision reconstruction strategy (one-stage vs. two-stage) post–failed ACL reconstruction. Twelve board-certified sports medicine orthopaedic surgeons independently applied the classification to the de-identified computed tomographic (CT) scan data of 10 patients, randomly selected, who failed ACL reconstruction. An interclass correlation coefficient (ICC) was calculated (with 95% confidence intervals) to assess agreement among reviewers concerning the three major classifications of the proposed system. Across surgeons, and on an individual patient basis, there was high internal validity and observed agreement on treatment strategy (one-stage vs. two-stage revision). Reliability testing of the classification using CT scan data demonstrated an ICC (95% confidence interval) of 0.92 (0.80–0.98) suggesting “substantial” agreement between the surgeons across all patients for all elements of the classification. The proposed REVISE ACL Classification, which employs CT scan analysis to both identify technical issues and guide revision ACL treatment strategy (one- or two-stage), constitutes a feasible and practical system with high internal validity, high observed agreement, and substantial inter-rater agreement. Adoption of this classification, both clinically and in research, will help provide a universal language for orthopaedic surgeons to discuss these complex clinical presentations and help standardize an approach to diagnosis and treatment to improve patient outcomes. The Level of Evidence for this study is 3.

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A Prospective Evaluation of Femoral Tunnel Placement for Anatomic Anterior Cruciate Ligament Reconstruction Using 3-Dimensional Magnetic Resonance Imaging

Cited by 30 publications

References 64 publications

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling

The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification

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