Anterior Cruciate Ligament Tunnel Placement

Wolf, Brian R.; Ramme, Austin J.; Britton, Carla; Amendola, Annunziato

doi:10.1055/s-0033-1364101

Cited by 14 publications

(3 citation statements)

References 56 publications

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“…However, our purpose with this study was not to determine how often these experienced knee surgeons chose the correct answer to the various topics of interest, but rather to discern how often they agreed on various factors associated with the cause(s) of graft failure and the accuracy of graft placement. Finally, the results of this study are potentially limited by the fact that experienced orthopedic knee surgeons (as shown in this as well as other studies 36-38 discussed above) do not uniformly agree on what constitutes “ideal” tunnel placement following ACL reconstruction. This objective can only be accomplished if 1) a simple, uniform definition of ideal tunnel location can be agreed upon based on validated anatomic and radiographic landmarks and reference points, and 2) this information is widely disseminated and utilized by surgeons who perform this procedure.…”

Section: Discussionmentioning

confidence: 76%

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Multirater Agreement of the Causes of Anterior Cruciate Ligament Reconstruction Failure

et al. 2014

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Background ACL reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. There is limited data regarding the agreement among orthopedic surgeons in terms of the etiology of primary ACL reconstruction failure and accuracy of graft tunnel placement. Purpose The purpose of this study is to test the hypothesis that experienced knee surgeons have a high level of inter-observer reliability in the agreement of the etiology of the primary ACL reconstruction failure, anatomical graft characteristics, tunnel placement. Methods Twenty cases of revision ACL reconstruction were randomly selected from the MARS database. Each case included the patient's history, standardized radiographs, and a concise 30-second arthroscopic video taken at the time of revision demonstrating the graft remnant and location of the tunnel apertures. 10 MARS surgeons not involved with the primary surgery reviewed all 20 cases. Each surgeon completed a two-part questionnaire dealing with each surgeon's training and practice as well as the placement of the femoral and tibial tunnels, condition of the primary graft, and the surgeon's opinion as to the etiology of graft failure. Inter-rater agreement was determined for each question. Inter-rater agreement was determined for each question with the kappa coefficient and prevalence adjusted bias adjusted kappa (PABAK). Results The 10 reviewers were in practice an average of 14 years. All performed at least 25 ACL reconstructions per year and 9 were fellowship-trained in sports medicine. There was wide variability in agreement among knee experts as to the specific etiology of ACL graft failure. When specifically asked about technical error as the cause for failure, inter-observer agreement was only slight (prevalence adjusted bias adjusted kappa [PABAK]: 0.26). There was fair overall agreement on ideal femoral tunnel placement (PABAK: 0.55), but only slight agreement whether a femoral tunnel was too anterior (PABAK: 0.24) and fair agreement whether it was too vertical (PABAK: 0.46). There was poor overall agreement for ideal tibial tunnel placement (PABAK: 0.17). Conclusion This study suggests that more objective criteria are needed to accurately determine the etiology of primary ACL graft failure as well as the ideal femoral and tibial tunnel placement in patients undergoing revision ACL reconstruction.

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Section: Discussionmentioning

confidence: 76%

“…Wolf et al 36 analyzed variation in ACL tunnel placement between surgeons and the influence of preferred surgical technique and surgeon experience using three-dimensional computed tomography. There was a relatively high degree of intra-surgeon reliability in the placement of ACL graft tunnels.…”

Section: Discussionmentioning

confidence: 99%

Multirater Agreement of the Causes of Anterior Cruciate Ligament Reconstruction Failure

et al. 2014

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“…Again, we performed an inter-surgeon and intra-surgeon tunnel variability study utilizing both cadavers and surgical patients to demonstrate that the MOON surgeons placed their tunnels in the same locations, and that the individual surgeons varied little in their tunnel placement from patient to patient. 25,26…”

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confidence: 99%