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ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to comparatively evaluate the accuracy of femoral tunnel positioning after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction performed with the remnant preservation (RP) technique versus the non-remnant preservation (NRP) technique.

Methods

A retrospective review of 145 patients who underwent ACL reconstruction from May 2020 to May 2022 were performed in this single-surgeon study. A total of 120 patients met the inclusion criteria and were allocated into two groups according to the surgical technique (i.e. RP group and NRP group). The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using a standardized grid system on the three-dimensional computed tomography (3D-CT) image. The accuracy and precision of the RP group were assessed based on published anatomical data in direct comparison with the NRP group.

Results

According to the surgical procedure, 57 of the 120 patients included were allocated into the RP group, and 63 into the NRP group. Significant differences were observed between the two groups in terms of tunnel position (posterior-to-distal (PD): 28.4 ± 5.4% (RP) vs. 31.8 ± 5.3% (NRP); P = 0.01), (anterior-to-posterior (AP): 32.6 ± 7.7% (RP) vs. 38.8 ± 7.7% (NRP); P = 0.00), while no significant differences were found in terms of the accuracy (8.6% (RP) vs. 8.9% (NRP); n.s) and precision (4.4% (RP) vs. 5.6% (NRP); n.s) of femoral tunnel positioning between the two groups.

Conclusions

From this single-surgeon study, it was concluded that there were no differences in the creation of ACL femoral tunnel between the RP technique and the non-remnant preserving technique. Meanwhile, the RP technique would not sacrifice the ideal position of the femoral tunnel and is able to retain the possible benefits of the ACL stump.

Level of evidence

Level III.

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Acknowledgements

We are grateful to the High Performance Computing Center of Central South University for partial support of this work.

Funding

This work was supported by the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University (2021KFJJ06) and Hunan Provincial Natural Foundation of China (2021JJ30040).

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, #87 Xiangya Road, Changsha, 410008, Hunan, China

    Weijie Liu, Yumei Wu, Xiaopeng Wang, Shida Kuang, Chao Su, Yilin Xiong, Hang Tang, Yifan Xiao & Shuguang Gao

  2. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China

    Yilin Xiong & Shuguang Gao

  3. Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China

    Yilin Xiong & Shuguang Gao

  4. National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Weijie Liu, Shida Kuang, Chao Su, Yilin Xiong, Hang Tang, Yifan Xiao & Shuguang Gao

Authors
  1. Weijie Liu
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  2. Yumei Wu
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  3. Xiaopeng Wang
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Contributions

All authors contributed substantially to conception and design. WL and YW performed the initial literature search and responsible for data analysing. WL wrote the draft and performed subsequent editing of the manuscript. YW and XP used software to import the original CT data to reconstruct 3D model. SK and CS performed all of the measurements. YX responsible for data checking. HT and YX responsible for patients’ data collecting. SG conceived the study and performed all of the surgery. All authors were involved in the editing of the manuscript (including approval of the final submission).

Corresponding author

Correspondence to Shuguang Gao.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved (ID NO.202107135; Ethics committee Xiangya Hospital, Central South University) by the Institutional Review Board.

Informed consent

All patients gave informed consent to participate to the study.

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Liu, W., Wu, Y., Wang, X. et al. ACL stump and ACL femoral landmarks are equally reliable in ACL reconstruction for assisting ACL femoral tunnel positioning. Knee Surg Sports Traumatol Arthrosc 31, 219–228 (2023). https://doi.org/10.1007/s00167-022-07084-2

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