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The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the current study was to investigate the potential effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in anatomic ACL reconstruction, using an ideal anatomic point as reference and evaluating postoperative tunnel placement based on 3D CT.

Methods

An experienced ACL surgeon, using the anatomic approach for femoral tunnel placement, relying on intraarticular landmarks and remnants of the torn ACL—and novel to the fluoroscopic assist—was introduced to its use. A prospective series of patients was included where group 1 (without fluoroscopy) and group 2 (with fluoroscopy) both had postoperative CT scans so that femoral tunnel position could be evaluated and compared to an ideal tunnel centre based on anatomic studies by using the Bernard and Hertel grid.

Results

Group 2, where fluoroscopy was used, had a mean femoral tunnel that was closer to the ideal anatomic centre than group 1. In the Bernard and Hertel grid, the distance in the high-low axis (y-axis) was found significantly closer (P = 0.001), whilst the deep-shallow axis (x-axis) and a total absolute distance were not significantly closer to the ideal described anatomic centre.

Conclusions

Intraoperative fluoroscopy was found effective as an aid for placing the femoral tunnel in a more accurate position, as compared to a desired anatomic centre. Although the concept of the “one-size-fits-all” approach for tunnel placement is debatable, the avoidance of grossly misplaced tunnels is the benefit of using fluoroscopy during ACL reconstruction. The authors hold that fluoroscopy is readily available, safe and easy to use and therefore a good aid in the anatomic approach for graft tunnel placement, for example, in a learning situation, in revision cases and when performing low volumes of such surgery.

Level of evidence

III.

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Author information

Authors and Affiliations

  1. Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway

    Eivind Inderhaug, Torbjørn Strand & Thomas Harlem

  2. Teres Bergen, Bergen, Norway

    Allan Larsen & Eirik Solheim

  3. Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

    Eivind Inderhaug, Per Arne Waaler & Eirik Solheim

Authors
  1. Eivind Inderhaug
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  2. Allan Larsen
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  3. Per Arne Waaler
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  4. Torbjørn Strand
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  5. Thomas Harlem
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  6. Eirik Solheim
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Corresponding author

Correspondence to Eivind Inderhaug.

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Appendix

Appendix

See Figs. 1, 2, 3, 4 and 5; Table 1.

Fig. 4
figure 4

Bland–Altman plot comparing the agreement of the two observers for the high-low measurements

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Fig. 5
figure 5

Bland–Altman plot comparing the agreement of the two observers for the deep-shallow measurements

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Inderhaug, E., Larsen, A., Waaler, P.A. et al. The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 1211–1218 (2017). https://doi.org/10.1007/s00167-015-3858-3

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  • DOI: https://doi.org/10.1007/s00167-015-3858-3

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