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Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the feedback from post-operative three-dimensional computed tomography (3D-CT) on femoral tunnel placement in the learning process, to obtain an anatomic anterior cruciate ligament (ACL) reconstruction.

Methods

A series of 60 consecutive patients undergoing primary ACL reconstruction using autologous hamstrings single-bundle outside-in technique were prospectively included in the study. ACL reconstructions were performed by the same trainee-surgeon during his learning phase of anatomic ACL femoral tunnel placement. A CT scan with dedicated tunnel study was performed in all patients within 48 h after surgery. The data obtained from the CT scan were processed into a three-dimensional surface model, and a true medial view of the lateral femoral condyle was used for the femoral tunnel placement analysis. Two independent examiners analysed the tunnel placements. The centre of femoral tunnel was measured using a quadrant method as described by Bernard and Hertel. The coordinates measured were compared with anatomic coordinates values described in the literature [deep-to-shallow distance (X-axis) 28.5%; high-to-low distance (Y-axis) 35.2%]. Tunnel placement was evaluated in terms of accuracy and precision. After each ACL reconstruction, results were shown to the surgeon to receive an instant feedback in order to achieve accurate correction and improve tunnel placement for the next surgery. Complications and arthroscopic time were also recorded.

Results

Results were divided into three consecutive series (1, 2, 3) of 20 patients each. A trend to placing femoral tunnel slightly shallow in deep-to-shallow distance and slightly high in high-to-low distance was observed in the first and the second series. A progressive improvement in tunnel position was recorded from the first to second series and from the second to the third series. Both accuracy (+52.4%) and precision (+55.7%) increased from the first to the third series (p < 0.001). Arthroscopic time decreased from a mean of 105 min in the first series to 57 min in the third series (p < 0.001). After 50 ACL reconstructions, a satisfactory anatomic femoral tunnel was reached.

Conclusion

Feedback from post-operative 3D-CT is effective in the learning process to improve accuracy and precision of femoral tunnel placement in order to obtain anatomic ACL reconstruction and helps to reduce also arthroscopic time and learning curve. For clinical relevance, trainee-surgeons should use feedback from post-operative 3DCT to learn anatomic ACL femoral tunnel placement and apply it appropriately.

Level of evidence

Consecutive case series, Level IV.

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Authors and Affiliations

  1. Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy

    Luigi Sirleo, Massimo Innocenti, Matteo Innocenti, Roberto Civinini, Christian Carulli & Fabrizio Matassi

Authors
  1. Luigi Sirleo
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  2. Massimo Innocenti
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  3. Matteo Innocenti
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  4. Roberto Civinini
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  5. Christian Carulli
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  6. Fabrizio Matassi
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Corresponding author

Correspondence to Luigi Sirleo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding sources were received for this study.

Ethical approval

The study and follow-up, respecting the criteria of the Declaration of Helsinki, has been approved by Institutional Review Board of Azienda Ospedaliera-Universitaria Careggi—Department of Surgery and Translational Medicine. The IRB number was DCMT2012/DIC/STUDI.SPER/2012.009.ORT.

Informed consent

All patients accepted the proposed treatment and follow-up after an adequate information and written consent.

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Sirleo, L., Innocenti, M., Innocenti, M. et al. Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement. Knee Surg Sports Traumatol Arthrosc 26, 468–477 (2018). https://doi.org/10.1007/s00167-017-4614-7

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  • DOI: https://doi.org/10.1007/s00167-017-4614-7

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