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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

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Accurate anatomic graft tunnel positioning is essential for the successful application of anatomic anterior cruciate ligament (ACL) reconstruction. The accurate insertion of the tibial tunnel (TT) remains challenging. Here, we explored a novel strategy of patient-specific drill template (PDT) for the placement of TT in ACL reconstruction and assessed its efficacy and accuracy.

Materials and methods

TT placement was randomized and performed by use of the PDT technique in 40 patients (PDT group) and the conventional arthroscopic technique in 38 patients (Arthroscopic group). After surgery, the deviations at the center point of the ACL tibial attachment area and radiological TT positioning were assessed in both groups. The preoperative and follow-up examinations included pivot-shift testing, KT-1000 arthrometer testing, the Lysholm and International Knee Documentation Committee scales were used to compare the knee stability and the functional state.

Results

The ideal center points achieved in the PDT group were more precise than that in the arthroscopic group (p < 0.001). Radiological TT positioning performed by use of the PDT technique was more accurate than that by the arthroscopic technique (p = 0.027). Statistical differences could not be found between the groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, the Lysholm or International Knee Documentation Committee scales. Both groups improved at follow-up compared with the preoperative assessment in terms of the pivot-shift test, the laxity tests, and scoring scales.

Conclusions

The novel PDT strategy could provide more accurate TT positioning than the traditional arthroscopic technique in ACL reconstruction. However, functional scales and stability tests gave similar results in the PDT and the standard techniques.

Level of evidence

I.

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(b reprinted from Ferretti et al. [6] with permission from Copyright Clearance Center)

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Acknowledgements

The authors would like to acknowledge Department of Radiology, Zhujiang Hospital, for providing image data for this study.

Funding

This work was funded by the Guangdong Provincial Scientific and Technique Department (Grant numbers: 2014A020212200 and 2015B010125005) and the Guangzhou Scientific and Technique Department (Grant numbers: 201704020129 and 201704020069).

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Author notes

  1. Meisong Zhu and Sijing Li contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Zhong Road, Guangzhou, Guangdong, China

    Meisong Zhu, Sijing Li, Zexin Su, Xiaoqi Zhou & Lijun Lin

  2. Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, 1023 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China

    Peng Peng & Jianyi Li

  3. Department of Orthopedics, Qingyuan People’s Hospital, B24 Xinchengyinquan Road, Qingcheng District, Qingyuan, Guangdong, China

    Jinping Wang

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  1. Meisong Zhu
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Correspondence to Jinping Wang or Lijun Lin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zhu, M., Li, S., Su, Z. et al. Tibial tunnel placement in anatomic anterior cruciate ligament reconstruction: a comparison study of outcomes between patient-specific drill template versus conventional arthroscopic techniques. Arch Orthop Trauma Surg 138, 515–525 (2018). https://doi.org/10.1007/s00402-018-2880-6

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