2023 ISAKOS Biennial Congress Paper
3D Printing Technology is a More Accurate Tool Than The Skill of an Experienced Surgeon to Reproduce Femoral Bone Tunnels In Multi-Ligament Knee Injuries
Núria Fernàndez Poch, MD, Barcelona, BARCELONA SPAIN
Ferran Fillat, MD, PhD, Sabadell, Barcelona SPAIN
Christian Yela, MD, Sant Cugat Del Vallés, Barcelona SPAIN
Mireia Gamundi López, Sabadell, Barcelona SPAIN
Sonia Carbó, MD, Sabadell, Barcelona SPAIN
Sergi Gil Gonzalez, MD, Igualada, Barcelona SPAIN
Xavier Pelfort, PhD, Igualada, Barcelona SPAIN
Hospital Universitari Parc Taulí , Sabadell, Barcelona, SPAIN
The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: I3PT Parc Taulí, 3D printed patient-specific instrumentation
Summary
A critical step in multiple-ligament knee reconstruction techniques is to avoid short tunnels or convergences among them. The use of 3D printed patient specific instrumentation provided accurate results for the creation of these tunnels and may be a promising tool to be used in the clinical practice.
Abstract
Objectives
Multiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Recent studies have recommended to drill the bone tunnels following different angulations on the coronal and axial planes to avoid any coalescence among them.
The aim of the study was to compare the accuracy of 3D printed patient-specific instrumentation (PSI) with a “freehand” of an expert surgeon for drilling lateral and medial femoral tunnels following these recommended angulations in multi-ligament knee injuries.
Methods
Ten cadaveric knees were scanned by computed tomography (CT) to identify anatomical femoral attachments of the lateral collateral ligament (LCL) and the Popliteal Tendon (PT) at the lateral side, and the Medial Collateral Ligament (MCL) and Posterior Oblique Ligament (POL) at the medial side.
Using a specific computed software, we planned four bone tunnels for each knee starting from the anatomical attachment of LCL, PT, MCL and POL applying the directions described above.
Ten 3D printed surgical guides (5 medial and 5 lateral) specifically designed for five knees were used to perform LCL, PT, MCL and POL tunnels. The tunnels of the others five knees were made freehand by the experienced knee surgeon.
Postoperative CT scans were made to each cadaveric knee. We assessed the accuracy of the tunnels by superimposing postoperative CT images onto preoperative ones and analyzed the deviation of performed tunnels from the planning, specifically the cortical entry point and the angular deviations.
Results
For all continuous data, the median was used as the central tendency measure, and interquartile ranges (Q1-Q3) were used as the measure of variance. For comparing variables among groups, we used Mann-Whitney test, with p values <0.05 counting as significant.
In “freehand” group, the mean entry point deviation was 5,45mm and interquartile range (Q1-Q3) was 2,59 - 8,84mm.
In “PSI” group and in PSI group the mean entry point deviation was 4,23mm and (Q1-Q3) was 3,59 – 5,73mm.
In “freehand” group, the mean angular deviation (º) was 22,28º and (Q1-Q3) was 17,65 – 25,21º.
In “PSI” group the mean angular deviation (º) was 5,59º and (Q1-Q3) was 4,04 – 8,25º (p value<0,001).
Conclusions
The use of 3D printed PSI provided significantly more accurate results relative to mean angular deviation than the skill of an experienced knee surgeon and may be a promising tool to be used in the clinical practice.