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Evaluating femoral graft placement using three-dimensional magnetic resonance imaging in the reconstruction of the anterior cruciate ligament via independent or transtibial drilling techniques: a retrospective cohort study

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Abstract

Purpose

Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure, yet failure still largely occurs due to nonanatomically positioned grafts. The purpose of this study was to retrospectively evaluate patients with torn ACLs before and after reconstruction via 3D MRI and thereby assess the accuracy of graft position on the femoral condyle.

Methods

Forty-one patients with unilateral ACL tears were recruited. Each patient underwent 3D MRI of both knees before and after surgery. The location of the reconstructed femoral footprint relative to the patient’s native footprint was compared.

Results

Native ACL anatomical location of the native ACL had a significant impact on graft position. Native ACLs that were previously more anterior yielded grafts that were more posterior (3.70 ± 1.22 mm, P = 0.00018), and native ACL that were previously more proximal yielded grafts that were more distal (3.25 ± 1.09 mm, P = 0.0042). Surgeons using an independent drilling method positioned 76.2% posteriorly relative to the native location, with a mean 0.1 ± 2.8 mm proximal (P = 0.8362) and 1.8 ± 3.0 mm posterior (P = 0.0165). Surgeons using a transtibial method positioned 75% proximal relative to the native location, with a mean 2.2 ± 3.0 mm proximal (P = 0.0042) and 0.2 ± 2.6 mm posterior (P = 0.8007). These two techniques showed a significant difference in magnitude in the distal–proximal axis (P = 0.0332).

Conclusion

The femoral footprint position differed between the native and reconstructed ACLs, suggesting that ACL reconstructions are not accurate. Rather, they are converging to a normative reference point that is neither anatomical nor isometric.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Janet Faith who was the research coordinator, Lyne Santello for coordinating MRI, and Dr Eric Lenczner, Dr Mark Burman and Dr Robert Marien for participating in this study.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada

    Jack Legler

  2. Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada

    Carl Laverdiere, Adam Hart & Paul A. Martineau

  3. Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada

    Mathieu Boily

  4. Department of Orthopedic Surgery, Fraser Health, Vancouver, Canada

    Magdalena Tarchala

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  1. Jack Legler
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  2. Carl Laverdiere
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Contributions

AH, PAM, and MB contributed to study conception and design; AH contributed to data acquisition; CL contributed to analysis and data interpretation; and CL, MT, and JL contributed to manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Jack Legler.

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Legler, J., Laverdiere, C., Boily, M. et al. Evaluating femoral graft placement using three-dimensional magnetic resonance imaging in the reconstruction of the anterior cruciate ligament via independent or transtibial drilling techniques: a retrospective cohort study. Eur J Orthop Surg Traumatol 34, 1297–1306 (2024). https://doi.org/10.1007/s00590-023-03788-4

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