Erschienen in:
15.11.2019 | KNEE
Intraoperative fluoroscopy reduces the variability in femoral tunnel placement during single-bundle anterior cruciate ligament reconstruction
verfasst von:
Seung-Suk Seo, Chang-Wan Kim, Chang-Rack Lee, Dae-Hyun Park, Yong-Uk Kwon, Ok-Gul Kim, Chang-Kyu Kim
Erschienen in:
Knee Surgery, Sports Traumatology, Arthroscopy
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Ausgabe 2/2020
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Abstract
Purpose
To evaluate the effect of using intraoperative fluoroscopy on femoral and tibial tunnel positioning variability in single-bundle anterior cruciate ligament (ACL) reconstruction.
Methods
A total of 80 consecutive patients with single-bundle ACL reconstruction between 2014 and 2016 were retrospectively reviewed. Among them, 40 underwent ACL reconstruction without fluoroscopy (non-fluoroscopy group) and 40 underwent fluoroscopy-assisted ACL reconstruction (fluoroscopy group). Femoral and tibial tunnel locations were evaluated using a standardized grid system with three-dimensional computed tomography images. Femoral and tibial tunnel location variability was compared between the groups.
Results
The operation time was longer in the fluoroscopy group than in the non-fluoroscopy group (61.3 ± 5.2 min vs. 55.5 ± 4.5 min, p < 0.001). In the fluoroscopy group, a guide pin was repositioned in 16 (40%) cases on the femoral side and 2 (5%) cases on the tibial side. No significant difference in the femoral tunnel location was observed between the fluoroscopy and non-fluoroscopy groups (anterior–posterior plane, 29.0% ± 3.2% vs. 30.0% ± 6.1%; proximal–distal plane, 30.8% ± 4.8% vs. 29.4% ± 8.3%; all parameters, n.s.); variability was significantly lower in the fluoroscopy group (p < 0.001 for both anterior–posterior and proximal–distal planes). No significant difference in the tibial tunnel location and variability was observed between the fluoroscopy and non-fluoroscopy groups (medial–lateral plane, 45.8% ± 2.0% vs. 46.6% ± 2.4%; anterior–posterior plane, 31.2% ± 4.0% vs. 31.0% ± 5.4%) (all parameters, n.s.).
Conclusions
Tunnel positioning with fluoroscopic assistance is feasible and effective in achieving consistency in femoral tunnel placement despite a slightly longer operation time. Intraoperative fluoroscopy can be helpful in cases wherein identifying anatomical landmarks on arthroscopy was difficult or for surgeons with less experience who performed ACL reconstruction.