2015 ISAKOS Biennial Congress ePoster #1215

Availability of Preoperative Planning of ACL Femoral Tunnel Position Using 3DCT

Yasunari Ikuta, MD, PhD, Hiroshima JAPAN
Kobun Takazawa, MD, PhD, Hiroshima JAPAN
Nobuo Adachi, MD, PhD, Hiroshima JAPAN
Masataka Deie, MD, PhD, Prof., Hiroshima, hiroshima JAPAN
Atsuo Nakamae, MD, PhD, Hiroshima JAPAN
Masakazu Ishikawa, MD, PhD, Kita-gun, Kagawa JAPAN
Tomoyuki Nakasa, MD, PhD, Matsuyama JAPAN
Ryo Shimizu, MD, Hiroshima JAPAN
Mitsuo Ochi, MD, PhD, Higashi, Hiroshima JAPAN
Hiroshima University, HIROSHIMA, JAPAN

FDA Status Not Applicable

Summary: We performed preoperatively planning of ACL femoral tunnel position using 3DCT. That was well matched with actually femoral tunnel position.

Abstract:

When we perform anterior cruciate ligament (ACL) reconstruction, the tunnel position is one of the most important factor for clinical result. Therefore, we compared preoperatively planning of femoral tunnel position using 3DCT with actually femoral tunnel position at immediately after reconstruction.
51 knees who had performed ACL reconstruction for one senior surgeon in our hospital from April 2013 to July 2014 included this study. All patients had evaluated with 3DCT preoperative and 2 days after reconstruction. We made femoral bone tunnel using trans-portal technique for all cases. The average age at reconstruction was 28.5 (13-62) years old. 33 male and 18 female was included. 31 knees had performed with single bundle reconstruction and 20 knees with double bundle reconstruction.
Preoperatively, the surgeon marked femoral tunnel position that he think well on 3DCT true lateral view. Postoperative 2 days, we evaluated 3DCT again and confirmed actual femoral tunnel position. Each results were measured with Quadrant technique and the value had compared.
The femoral tunnel position for single bundle reconstruction is 22.4/30.3% preoperatively and 27.0/41.1% postoperatively. Actual tunnel position is significantly anterior-distal with preoperative planning (p=0.0489/0.0052). On the other hand, that for double bundle reconstruction is 21.0/11.1% (anteromedial bundle (AMB)) and 27.2/44.8% (psterolateral bundle (PLB)) preoperatively, 22.6/23.9% (AMB) and 30.4/50.5% (PLB) postoperatively. Only the femoral tunnel position of AMB was significantly distal (p=0.0017) but on the others article there were no significant differences. So we think that we can make ideal femoral tunnel position.
We think several reason for differences between preoperative planning and actual position of femoral tunnel for single bundle technique:cartilage evaluation using 3DCT is poor, 3DCT evaluation is used true lateral view but arthroscopic finding is from anterior portal and on arthroscopy we tend to avoid posterior wall injury. However the femoral tunnel position of this study was similarly with the anatomical ACL femoral footprint of cadaveric studies. In future, we need inspection of relationship with clinical results, bone tunnel widening and so on.