Can Surgeons Identify ACL Femoral Ridges Landmark and Optimal Tunnel Position? A 3D Model Study

Laverdière, Carl; Schupbach, Drew; Schupbach, Justin; Harvey, Eric; Boily, Mathieu; Burman, Mark; Martineau, Paul A.

doi:10.1016/j.asmr.2020.05.008

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Since femoral tunnel malposition is the most critical reason for ACL failures reported by 80% of surgeons [25], accurate femoral tunnel placement is one of the most vital steps in ACLR. Although the freehand technique guided by ridges and residual stump is most commonly used by our surgeons (56.5%), a laboratory study confirmed that the freehand technique, even in the hand of sports fellowship-trained surgeons, resulted in gross errors in femoral tunnel placement on a 3D model [26]. Furthermore, ridges (bifurcate and intercondylar) alone may not be the best option to identify the center of the femoral footprint because of variability in the visibility of ridges during arthroscopic surgery and anatomical variability of ridges [27].…”

Section: B) Intra-operative Trendsmentioning

confidence: 72%

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Pandey

Madi

Thonse

et al. 2022

JOIO

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Background Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. Methods A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. Results 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. Conclusion Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.

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Section: B) Intra-operative Trendsmentioning

confidence: 72%

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Pandey

Madi

Thonse

et al. 2022

JOIO

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“…Finally, 22 patients were in the good position group, 62 patients were in the poor position group, and the rate of good bone tunnel position was only 26.2%. Moloney et al showed that if only depending on bone landmarks, the femoral positioning site might be deviated by > 2.5 mm from the original footprint center by more than half of surgeons, indicating that the positioning by intra-articular bone landmarks was not reliable [ 9 , 15 , 21 ]. The findings were in agreement with the results of the present study, which showed that the positions of femoral tunnels were not concentrated, and the rate of good bone tunnel position was low.…”

Section: Discussionmentioning

confidence: 99%

“…Some other studies reported that the resident’s ridge could be observed in approximately 88% of patients in the case group, while the bifurcate ridge could only be found in approximately 48% of patients [ 17 ]. Moloney et al reported that if depending on bone landmarks only, the femoral positioning site might be deviated by > 2.5 mm from the original footprint center by more than half of surgeons [ 15 ]. These findings suggested that the bone landmarks might not always appear, and the selection of the bone tunnel site should not be performed exclusively depending on this positioning landmark.…”

Section: Introductionmentioning

confidence: 99%

Distribution of bone tunnel positions and treatment efficacy of bone landmark positioning method for anatomical reconstruction of the anterior cruciate ligament: a case control study

Yan¹,

Gao²,

He³

et al. 2023

BMC Musculoskelet Disord

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Background This study aimed to investigate the distribution of femoral tunnel and explore the influences of bone tunnel positions on knee functions. The bone landmark positioning method was used to position the femoral tunnel during the anatomical reconstruction surgery in patients with anterior cruciate ligament (ACL) rupture. Methods Data of patients who underwent anatomical reconstruction of the ACL between January 2015 and July 2018, were retrospectively analyzed. The distribution of the femoral tunnel was recorded on 3-D CT after surgery. The tunnel positions were classified into good and poor position groups based on whether the position was in the normal range (24–37% on the x-axis and 28–43% on the y-axis). The Lysholm and IKDC scores, KT-1000 side-to-side difference, pivot shift test and Lachman test results of the knee joints were recorded, and then the differences in knee joint functions between the two groups were analyzed. Results 84 eligible patients (84 knees) were finally included in this study. Twenty-two and 62 of the patients were categorized in the good and poor position groups, respectively, and the rate of good position was 26.2%. The distribution of bone tunnel was as follows: (x-axis) deep position in 10 patients (12%), normal position in 58 patients (69%), and shallow position in 16 patients (19%); (y-axis) high position in 54 patients (64%), normal position in 26 patients (31%), and low position in 4 patients (5%). 1 year later, the Lysholm and IKDC scores were significantly better in the good position group (P < 0.05), the KT-1000 side to side difference, the pivot shift test and Lachman test results were better in the good position group (P < 0.05). Conclusions The bone tunnels were found to be distributed in and beyond the normal range using the bone landmark method to position the femoral tunnel in the single-bundle anatomical reconstruction of ACL, while the rate of good bone tunnel position was low. The knee joint function scores and stability were lower in patients with poor position of the femoral tunnel.

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Role of 3D printing in sports and prosthetics

Patralekh,

Mohanta,

Lal

2024

Additive Manufacturing Materials and Technology

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Can Surgeons Identify ACL Femoral Ridges Landmark and Optimal Tunnel Position? A 3D Model Study

Cited by 3 publications

References 22 publications

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Distribution of bone tunnel positions and treatment efficacy of bone landmark positioning method for anatomical reconstruction of the anterior cruciate ligament: a case control study

Role of 3D printing in sports and prosthetics

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