2015 ISAKOS Biennial Congress ePoster #1329

Evaluation of Femoral Socket Aperture Position in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using Three-Dimensional Fluoroscopy Navigation

Shuji Taketomi, MD, PhD, Tokyo JAPAN
Hiroshi Inui, PhD, Tokyo JAPAN
Ryota Yamagami, MD, Tokyo JAPAN
Takaki Sanada, MD, Kawasaki, Kanagawa JAPAN
Keitaro Tahara, MD, Tokyo JAPAN
Nobuyuki Shirakawa, MD, Tokyo JAPAN
Sakae Tanaka, MD, PhD, Tokyo JAPAN
Takumi Nakagawa, MD, PhD, Tokyo JAPAN
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, JAPAN

FDA Status Not Applicable

Summary: By using three-dimensional fluoroscopy-based navigation, the anatomical placement of femoral sockets during remnant-preserving anterior cruciate ligament reconstruction was as precise as that observed in anterior cruciate ligament reconstruction without remnant preservation.

Abstract:

Introduction

Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and the recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. We have used a three-dimensional (3D) fluoroscopy-based navigation system to create an anatomical femoral socket during technically demanding remnant-preserving ACL reconstruction. The purpose of this study was to compare the position of the femoral socket during remnant-preserving ACL reconstruction to that observed in conventional ACL reconstruction using 3D fluoroscopic navigation.

Materials And Methods

The study included 140 patients who underwent double-bundle ACL reconstruction using hamstring tendons or rectangular tunnel ACL reconstruction using bone–patellar tendon–bone (BPTB) graft with the assistance of a 3D fluoroscopy-based navigation system. Three-dimensional computed tomography (CT) was conducted 1 week after surgery. Of the 93 patients who underwent ACL reconstruction without remnant preservation, 47 received hamstring tendon grafts and 46 received BPTB grafts. On the other hand, of the 47 patients who underwent ACL reconstruction with remnant preservation, 18 received hamstring tendon grafts, whereas 29 received BPTB grafts. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D CT of the operated knee. Radiographic parameters were compared using Student’s t-test. Statistical significance was set at P < 0.05.

Results

In double-bundle ACL reconstruction using hamstring tendon grafts with remnant tissue preservation, the center of the anteromedial (AM) socket aperture was located at 25.5% ± 4.7% in the horizontal direction and 34.3% ± 8.0% in the vertical direction, whereas that of the posterolateral (PL) socket aperture was located at 32.9% ± 5.6% in the horizontal direction and 57.5% ± 5.8% in the vertical direction. On the other hand, in double-bundle reconstruction without remnant preservation, the center of the AM socket aperture was located at 23.6% ± 4.4% in the horizontal direction and 36.1% ± 7.3% in the vertical direction, whereas that of the PL socket aperture was located at 33.6% ± 5.5% in the horizontal direction and 60.6% ± 6.2% in the vertical direction. In ACL reconstruction using a rectangular BPTB graft, the center of the femoral socket aperture was located at 29.1% ± 4.2% in the horizontal direction and at 51.0% ± 9.8% in the vertical direction when the remnant tissue was preserved, and at 27.6% ± 4.7% in the horizontal direction and 50.1% ± 7.1% in the vertical direction when the remnant tissue was not preserved. No significant difference in the location of the socket aperture was observed between the remnant preservation and nonpreservation groups, regardless of ACL reconstruction using hamstring tendon grafts or BPTB grafts.

Conclusions

By using 3D fluoroscopy-based navigation, the anatomical placement of femoral sockets during remnant-preserving ACL reconstruction using hamstring tendon grafts or BPTB grafts was as precise as that observed in ACL reconstruction without remnant preservation.