Tibial tunnel placement in anatomic anterior cruciate ligament reconstruction: a comparison study of outcomes between patient-specific drill template versus conventional arthroscopic techniques

Zhu, Meisong; Li, Sijing; Su, Zexin; Zhou, Xiaoqi; Peng, Peng; Li, Jianyi; Wang, Jinping

doi:10.1007/s00402-018-2880-6

Cited by 12 publications

(21 citation statements)

References 46 publications

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“…During anterior cruciate ligament (ACL) reconstruction, the tibial footprint of the ACL could be seen easily without sacrificing the remnant ACL. 8 However, the ACL footprint of the femoral side is difficult to visualize using anterior arthroscopic portal without sacrificing the remnant ACL because of the blockage caused by the remnant of the ACL or the ridge of medial wall of the lateral femoral condyle. [9][10][11][12] Therefore, techniques are being used to attain both aims such as posterolateral (PL) viewing with a 70-degree scope and transseptal portal viewing.…”

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confidence: 99%

Different Strategies in Making Transseptal Portal for the Different Purposes

et al. 2019

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AbstractThe purpose of this study was to find the most suitable and safe position of the transseptal portal in anatomic anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions. The hypothesis of this study was that area and position of the transseptal portal are different between ACL and PCL reconstructions for the observation of native footprint. A matched-pair comparison study was conducted on the arthroscopic images of 100 consecutive patients who underwent ACL reconstruction and 50 consecutive patients who underwent PCL reconstruction. The transseptum was divided into six compartments. The opened compartments for each surgery were then evaluated to find which anatomical structures are well seen. The anterior middle and upper parts were necessary for the ACL reconstruction, whereas middle and lower portions of the anterior and posterior compartments were necessary for the PCL reconstruction. A larger opening was necessary for PCL reconstruction than that for ACL reconstruction. The ACL posterior one-third, ACL femoral attachment, and apex of the deep cartilage margin (DCM) were viewed in 100% of the patients during ACL reconstruction. The PCL posterior one-third, PCL tibial attachment, PCL fovea margin, and medial meniscus around posterior margin were always viewed during PCL reconstruction. The anterior part of the septum, from the middle to the upper portions of the transseptum, was necessary to be opened for visualization of the femoral footprint and DCM of the lateral femoral condyle during ACL reconstruction. The anterior and posterior parts of the septum, from the middle to the lower portions of the transseptum, were necessary for excellent visualization of the PCL tibial footprint during PCL reconstruction. These paths of the transseptal portal for each surgery will help surgeons obtain both anatomic footprint restoration and maximal remnant preservation through the most suitable and safe means. This is a case–control study; level of evidence is 3.

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confidence: 99%

Different Strategies in Making Transseptal Portal for the Different Purposes

et al. 2019

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“…It should assist minimally invasive temporomandibular joint arthrocentesis or arthroscopy to combine the potential advantages of these novel techniques and first clinical results are presented. This is the first known report of template-guided therapy in the TMJ other than the use of a cutting guide for tumor resection [10] and one of the first considering joint surgery besides arthroplasty resection guides [11].…”

Section: Introductionmentioning

confidence: 99%

Template-based temporomandibular joint puncturing and access in minimally invasive TMJ surgery (MITMJS) – a technical note and first clinical results

et al. 2019

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Background Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions. To improve TMJ access, a workflow to create surgical templates is introduced. Methods A workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. In a first clinical trial 3 patients (6 joints) were treated by way of template-guided endoscopically-assisted TMJ therapy (3 arthrocenteses and 3 arthroscopies). Results Generation and clinical use of the templates was as planned. All templates showed perfect fit and permitted instant access to the TMJ. All surgeries were performed without complications. Conclusions Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. An important issue is the capability to dis- and remount the template during surgery. Using in-house production, costs are affordable. Trial registration This study was registered at the Ethic Committee of the Berlin Medical Chamber ( Eth-30/17 , 12/06/2017).

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“…The age of participants ranged from 14 to 54 years (391 patients) [1, 7, 12, 20, 43, 59] and follow‐up ranged from 12 to 60 months (775 patients) [1, 7, 12, 14, 20, 22, 27, 30, 31, 43, 59]. Three studies used computer‐assisted fluoroscopic navigation (142 patients) [7, 22, 27], 1 study used intraoperative fluoroscopy (60 patients) [1], 2 studies used personalized 3D‐printed drill guides following pre‐operative imaging (119 patients) [30, 59], and 5 studies used image‐free computer‐assisted navigation systems (454 patients) [12, 14, 20, 31, 43]. One study performed double‐bundle ACL reconstruction (60 patients) [1] and 1 study had a double‐bundle (DB) group in addition to its single‐bundle (SB) group in the technology‐assisted surgery group (55 patients, 37 patients excluding the DB group) [27].…”

Section: Resultsmentioning

confidence: 99%

“…One study (209 patients) demonstrated a signiicant increase in cost associated with use of computer-assisted navigation systems (mean 1158€ or approximately $1269 USD) versus conventional surgery (mean 704€ or approximately $771 USD) [31]. Of the two studies using 3D-printed templates, production costs ranging from $10 to $42 USD (approximately 9.1 € to 38.2 €) were cited [30,59]. Fig.…”

Section: Operative Length and Costmentioning

confidence: 99%

Technology‐assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta‐analysis

Yavari,

Moosa,

Cohen

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose To investigate the efect of technology-assisted Anterior Cruciate Ligament Reconstruction (ACLR) on postoperative clinical outcomes and tunnel placement compared to conventional arthroscopic ACLR. Methods CENTRAL, MEDLINE, and Embase were searched from January 2000 to November 17, 2022. Articles were included if there was intraoperative use of computer-assisted navigation, robotics, diagnostic imaging, computer simulations, or 3D printing (3DP). Two reviewers searched, screened, and evaluated the included studies for data quality. Data were abstracted using descriptive statistics and pooled using relative risk ratios (RR) or mean diferences (MD), both with 95% conidence intervals (CI), where appropriate. Results Eleven studies were included with total 775 patients and majority male participants (70.7%). Ages ranged from 14 to 54 years (391 patients) and follow-up ranged from 12 to 60 months (775 patients). Subjective International Knee Documentation Committee (IKDC) scores increased in the technology-assisted surgery group (473 patients; P = 0.02; MD 1.97, 95% CI 0.27 to 3.66). There was no diference in objective IKDC scores (447 patients; RR 1.02, 95% CI 0.98 to 1.06), Lysholm scores (199 patients; MD 1.14, 95% CI − 1.03 to 3.30) or negative pivot-shift tests (278 patients; RR 1.07, 95% CI 0.97 to 1.18) between the two groups. When using technology-assisted surgery, 6 (351 patients) of 8 (451 patients) studies reported more accurate femoral tunnel placement and 6 (321 patients) of 10 (561 patients) studies reported more accurate tibial tunnel placement in at least one measure. One study (209 patients) demonstrated a signiicant increase in cost associated with use of computer-assisted navigation (mean 1158€) versus conventional surgery (mean 704€). Of the two studies using 3DP templates, production costs ranging from $10 to $42 USD were cited. There was no diference in adverse events between the two groups. Conclusion Clinical outcomes do not difer between technology-assisted surgery and conventional surgery. Computer-assisted navigation is more expensive and time consuming while 3DP is inexpensive and does not lead to greater operating times. ACLR tunnels can be more accurately located in radiologically ideal places by using technology, but anatomic placement is still undetermined because of variability and inaccuracy of the evaluation systems utilized. Level of evidence Level III.

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Tibial tunnel placement in anatomic anterior cruciate ligament reconstruction: a comparison study of outcomes between patient-specific drill template versus conventional arthroscopic techniques

Abstract: I.

Cited by 12 publications

References 46 publications

Different Strategies in Making Transseptal Portal for the Different Purposes

Different Strategies in Making Transseptal Portal for the Different Purposes

Template-based temporomandibular joint puncturing and access in minimally invasive TMJ surgery (MITMJS) – a technical note and first clinical results

Technology‐assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta‐analysis

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