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Plain radiographs can be used for routine assessment of ACL reconstruction tunnel position with three-dimensional imaging reserved for research and revision surgery

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

Abstract

Purpose

The position of the osseous tunnels and graft during anterior cruciate ligament (ACL) reconstruction has been the subject of multiple studies aiming for either anatomical placement or an alternative. The assessment of these positions, using post-operative imaging, is therefore of interest to the surgeon in both the evaluation of surgical performance and surveillance of potential complications. The purpose of this review is to identify the optimal use of imaging in both the surveillance of clinical practice and in planning revision surgery.

Methods

A comprehensive systematic review was performed using Medline and Pubmed searches to identify radiological methods used to assess ACL reconstruction tunnel position. Commonly used methods were identified with correlation to either native anatomy or clinical results.

Results

The findings suggest that plain radiographs can be used to assess tunnel position and identify grafts that are positioned non-anatomically and may be at increased risk of complications. Computer tomography (CT) offers additional information about the tunnel aperture shape and size that is of importance for revision surgery and research projects whilst magnetic resonance imaging (MRI) provides further assessment of both graft integrity and associated soft tissue damage.

Conclusion

In the surveillance of routine clinical practice, plain radiographs are sufficient to define tunnel position. The additional information provided by three-dimensional imaging is only required in revision surgery or research studies.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

AM:

Anteromedial

AP:

Anteroposterior

CT:

Computer tomography

FTA:

Femoral tunnel angle

ICC:

Intraclass correlation coefficient

IKDC:

International Knee Documentation Committee

MRI:

Magnetic resonance imaging

PCC:

Pearson’s Correlation Coefficient

THL:

Tibial horizontal line

3D-CT:

Three-dimensional computer tomography

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Acknowledgements

The authors wish to acknowledge the contribution of Mr Robert McNinch who was involved in the original literature search and writing of the introduction.

Authors’ contributions

JK was involved in the literature search, produced the summary (with tables), and was involved in the writing, formatting and editing of the manuscript. VM conceived the review, coordinated the review and edited the manuscript. Both authors have read and approved the final manuscript.

Author information

Authors and Affiliations

  1. ST8 Registrar in Trauma and Orthopaedics, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK

    Jonathan David Kosy

  2. Consultant Orthopaedic Surgeon with Specialist Interest in Knee Surgery, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK

    Vipul I. Mandalia

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  1. Jonathan David Kosy
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Correspondence to Jonathan David Kosy.

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Kosy, J.D., Mandalia, V.I. Plain radiographs can be used for routine assessment of ACL reconstruction tunnel position with three-dimensional imaging reserved for research and revision surgery. Knee Surg Sports Traumatol Arthrosc 26, 534–549 (2018). https://doi.org/10.1007/s00167-017-4462-5

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