Summary

Indigenously designed grid along with Image Intensifier increases the accuracy of tunnel placement and long term functional outcome of arthroscopic ACL reconstruction

Abstract

Purpose

The purpose of this study was to evaluate the accuracy in the femoral and tibial tunnel placement after use of fluoroscopy along with indigenously designed grid method to assist in Arthroscopic Anterior cruciate ligament reconstruction (ACLR) as compared to the tunnel placement when fluoroscopy and indigenously designed grid method was not used and validate the findings with 3D CT scan done postoperatively along with assessing the functional outcome at a minimum of three years of follow up.

Methods

This was a prospective study conducted on patients who underwent primary ACLR. A total of 113 consecutive patients were included and segregated into non-fluoroscopy (group B) and fluoroscopy group (group A) and both had postoperative CT scans so that femoral and tibial tunnel position could be evaluated. Scheduled follow ups were at 3, 6, 12, 24, and 36 months postoperatively. Patients were evaluated objectively with Lachman test, measurement of range of motion and functional outcome using PRO measures i.e., TLK, KOOS, and IKDC scores.

Results

The average location of femoral tunnel showed significant differences between the two groups. However, the variability in femoral tunnel location was significantly lower in group A as compared to group B for proximal-distal planes only. The average location of the tibial tunnel as per Bernard & Hertel grid showed significant differences in both the planes. The variability in tibial tunnel was higher in medial-lateral plane as compared to anterior-posterior plane. There was statistically significant difference in mean value of the three scores among the two groups. The variability of the scores were higher in group B as compared to group A. None of the patient was reported as failure.

Conclusions

It’s safe to conclude that tunnel placement using fluoroscopy will increase the accuracy and ease of positioning in both new and experienced hands of surgeons along with better outcomes clinically and subjectively.