Dataset Information

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

ABSTRACT: Purpose:To examine the ability of surgeons to identify the osseous landmarks associated with the femoral anterior cruciate ligament (ACL) footprint and locate optimal tunnel placement on 3-dimensional (3D) printed models compared with intraoperative placement. Methods:Twelve sports fellowship-trained orthopaedic surgeons were asked to identify a femoral landmark and an ACL footprint on 10 different 3D printed knees. The 3D models were made based on 20 real patients with different anatomical morphology who later received ACL reconstructive surgery using independent drilling. ImageJ software was used to quantify the measurements, which were then analyzed using descriptive statistics. Results:Overall, none of the surgeons were able to consistently identify the junction of the bony ridges. The mean error per participant ranged from 2.81 to 7.34 mm in the proximal direction (P = 3.30e-05) and from 2.42 to 8.05 mm in the posterior direction (P =4.88e-12). None of the surgeons were able to appropriately identify the center of the femoral footprint on the anatomic 3D models. The difference between the center of the footprint surgeons identified on the 3D model and the tunnel graft location in surgery was significantly different (P = .0046). On average, the magnitude of the error when the surgeons performed the actual surgery was 3.72 ± 2.43 mm, whereas on the 3D models it was 5.82 ± 1.97 mm. Conclusions:Experienced sports fellowship-trained orthopaedic surgeons were unable to correctly identify the junction of the intercondylar and bifurcate ridges and the native ACL footprint on 3D models. Operatively placed tunnels were more accurate implying that looking either through a scope or soft-tissue landmarks play a significant role in surgeons ACL footprint localization. Clinical Relevance:The graft position for ACL reconstruction plays an important role on the kinematics of the knee. This paper shows that soft tissue landmarks are needed to provide reliable reference points for reconstruction.

SUBMITTER: Laverdiere C

PROVIDER: S-EPMC7451917 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Laverdiere Carl C Schupbach Drew D Schupbach Justin J Harvey Eric E Boily Mathieu M Burman Mark M Martineau Paul A PA

Arthroscopy, sports medicine, and rehabilitation 20200729 4

<h4>Purpose</h4>To examine the ability of surgeons to identify the osseous landmarks associated with the femoral anterior cruciate ligament (ACL) footprint and locate optimal tunnel placement on 3-dimensional (3D) printed models compared with intraoperative placement.<h4>Methods</h4>Twelve sports fellowship-trained orthopaedic surgeons were asked to identify a femoral landmark and an ACL footprint on 10 different 3D printed knees. The 3D models were made based on 20 real patients with different ...[more]

PMID: 32875301

Similar Datasets

Project description:PurposeThe purpose of this study was to visualize and quantify the positions of femoral and tibial tunnels in patients who underwent traditional transtibial single-bundle ACL reconstruction, as performed by multiple surgeons, utilizing 3D CT models, and to compare these positions to our previously reported anatomical tunnel positions.MethodsFifty-eight knee computed tomography (CT) scans were performed on patients who underwent primary or revision transtibial single-bundle ACL reconstruction, and three-dimensional reconstructions of the CT scans were aligned within an anatomical coordinate system. The position of femoral tunnel aperture centers was measured with (1) the quadrant method and (2) in the anatomic posterior-to-anterior and proximal-to-distal directions. The position of tibia tunnel aperture centers were measured similarly, in the anterior-to-posterior and medial-to-lateral dimensions on the tibial plateau. Comparisons were made to previously established anatomical tunnel positions, and data were presented as "mean value ± standard deviation (range)."ResultsThe location of tibial tunnels was at 48.0 ± 5.4% (35.6-59.5%) of the anterior-to-posterior plateau depth and at 47.9 ± 2.9% (42.2-57.4%) of the medial-to-lateral plateau width. The location of femoral tunnels was at 55.8 ± 8.0% (41.5-79.5%) in the anatomic posterior-to-anterior direction and at 41.2 ± 10.4% (15.1-67.4%) in the proximal-to-distal directions. Utilizing a quadrant method, femoral tunnels were positioned at 37.4 ± 5.1% (24.9-50.6%) from the proximal condylar surface, parallel to Blumensaat line, and at 11.0 ± 7.3% (-6.0-28.7%) from the notch roof, perpendicular to Blumensaat line. In summary, tibial tunnels were positioned medial to the anatomic PL position (p < 0.001), and femoral tunnels were positioned anterior to both AM and PL anatomic tunnel locations (p < 0.001 and p < 0.001).ConclusionACL reconstruction via traditional transtibial technique fails to accurately position femoral and tibial tunnels within the native ACL insertion site. To achieve anatomical graft placement, other surgical techniques should be considered.Level of evidenceIV.

Project description:BackgroundIndependent transtibial pullout repair is a common surgical technique for repairing lateral meniscus posterior root tears (LMPRTs). The shared anterior cruciate ligament (ACL) bone tunnel technique is an alternative technique for LMPRT repair combined with ACL reconstruction (ACLR) to avoid the establishment of additional bone tunnels.PurposeTo compare the clinical outcomes of the shared ACL bone tunnel versus the independent transtibial pullout techniques for LMPRT repair combined with ACLR.Study designCohort study; Level of evidence, 3.MethodsBetween March 2014 and February 2018, a total of 48 patients were diagnosed with ACL injury with concomitant LMPRT; 22 patients underwent independent transtibial pullout repair (group T), and 26 patients underwent the shared ACL bone tunnel technique (group S). At a follow-up of >2 years, we compared knee functional recovery using the Lysholm, Tegner, and International Knee Documentation Committee scores and the pivot-shift test. Lateral meniscal extrusion, and cartilage degeneration on magnetic resonance imaging (MRI) scans were also compared. The healing status of the lateral meniscus posterior root was compared using second-look arthroscopy and MRI.ResultsThe duration of surgery was significantly shorter in group S compared with group T (98.3 ± 11.1 vs 127.9 ± 17.5 min; P = .001). At final follow-up, there were no significant differences between the 2 groups in knee functional scores, pivot shift, or grade of cartilage degeneration. Lateral meniscal extrusion was decreased in group S compared with group T (2.41 ± 0.61 vs 1.59 ± 1.35 mm; P = .014). Second-look arthroscopy revealed stable healing in 16 of 18 patients (88.9%) in group S and 10 of 15 patients (66.7%) in group T (P = .38).ConclusionBoth the shared ACL bone tunnel and the independent transtibial pullout techniques led to satisfactory clinical outcomes. The shared ACL bone tunnel technique is the simpler of the 2 procedures for combined LMPRT repair with ACLR.

Project description:BackgroundIn anterior cruciate ligament (ACL) reconstruction, minimizing the graft-tunnel motion (GTM) will promote graft-to-bone healing and avoid graft loosening or tearing as well as potential bone tunnel enlargement. A nearly isometric state of the graft can be achieved by placing the tunnel properly to theoretically gain better graft-to-bone healing. However, little clinical evidence is available to quantify the relation between GTM and tunnel position.PurposeTo find the proper zones for the femoral and tibial tunnel apertures that minimize the GTM, referred to as the "nearly isometric zone," through use of intraoperative GTM measurement and 3-dimensional computed tomography (3D-CT).Study designCross-sectional study; Level of evidence, 3.MethodsA total of 100 patients were enrolled in this study. Nearly isometric ACL reconstruction was performed, and an intra-articular GTM measuring device was designed to measure and record the amplitude of GTM while the knee was flexed from 0° to 120°. Postoperatively, the patients underwent multislice CT, and the images were used to create 3D-CT models. After tibial aperture examination, 5 patients were excluded due to the divergence of tibial aperture, and therefore 95 patients remained in the study. Patients were divided into 2 groups according to whether the lateral intercondylar ridge was absent or present. The Bernard-Hertel grid coordinates (h, t) of the femoral tunnel were then quantified.ResultsThe maximal GTM (mGTM) was a mean ± SD of 1.06 ± 0.66 mm (range, 0.0-3.0 mm). The mGTM in patients with a lateral intercondylar ridge was significantly lower than that in patients without a lateral intercondylar ridge (0.81 ± 0.39 vs 1.59 ± 0.73 mm, respectively; P < .0001). The average h and t were 0.227 ± 0.079 and 0.429 ± 0.770, respectively. Notably, in 1 patient, the mGTM was 0 mm whereas the coordinates (h, t) of the femoral tunnel were 0.250 and 0.255. The overall GTM slowly increased before 90° but increased significantly after the knee was bent 105° (P = .010). Correlation analysis showed that the t coordiinate had significant correlation with mGTM (R = 0.581; P < .001). A gradient pattern was created to show the nearly isometric blue zone (mGTM <0.5 mm), which was found to overlap with the IDEAL (isometric, direct insertion, eccentric, anatomic, low tension-flexion pattern) position.ConclusionA method of measuring intraoperative GTM and quantifying femoral tunnel position on postoperative 3D-CT was successfully developed. The presence of a lateral condylar ridge can significantly reduce mGTM. A nearly isometric zone was described that was consistent with the IDEAL concept.

Dataset Information

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

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets