A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Jonathan D Kosy, Katie Walmsley, Akash D Sharma, Elizabeth A Gordon, Sadie V Heddon, Rahul Anaspure, Peter J Schranz, Vipul I Mandalia, Jonathan D Kosy, Katie Walmsley, Akash D Sharma, Elizabeth A Gordon, Sadie V Heddon, Rahul Anaspure, Peter J Schranz, Vipul I Mandalia

Abstract

Background: Graft malposition is a risk factor for failure of anterior cruciate ligament reconstruction. A 70° arthroscope improves visualisation of the medial wall of the lateral femoral condyle without switching portals. We investigated whether the use of this arthroscope affected the accuracy and precision of femoral tunnel placement.

Methods: Fifty consecutive adult patients were recruited. Following one withdrawal and two exclusions, 47 patients (30 in group 1 (70° arthroscope), 17 in group 2 (30° arthroscope)) underwent three-dimensional computed tomography imaging using a grid-based system to measure tunnel position.

Results: No difference was found in the accuracy or precision of tunnels (mean position: group 1 = 33.3 ± 6.0% deep-shallow, 27.2 ± 5.2% high-low; group 2 = 31.7 ± 6.9% deep-shallow, 29.0 ± 6.2% high-low; not significant). A post-hoc power analysis suggests a study of 106 patients would be required.

Conclusions: This pilot study suggests that tunnel position is not affected by the arthroscope used. An appropriately powered study could investigate this finding alongside other potential benefits of using a 70° arthroscope for this procedure.

Trial registration: ClinicalTrials.gov, NCT02816606. Registered on 28 June 2016.

Keywords: Accuracy; Anterior cruciate ligament reconstruction; Arthroscope; Femoral tunnel.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Arthroscopic view of femoral anterior cruciate ligament footprint in the right knee. a 30° arthroscope (via anteromedial portal); b 70° arthroscope (via anterolateral portal)
Fig. 2
Fig. 2
Tunnel position calculation. Three-dimensional computed tomography reconstruction image in true lateral position with digital subtraction of medial femoral condyle. Deep–shallow position = a/b; high–low position = c/d
Fig. 3
Fig. 3
Calculation of difference between centre of tunnel aperture (AC; red square) and anatomical centre of anteromedial bundle (TC; blue triangle) shown on three-dimensional computed tomography reconstructed image; measurements a and b parallel and perpendicular (respectively) to Blumensaat’s line (on expanded view, distance c = √(a2 + b2))
Fig. 4
Fig. 4
Tunnel aperture centres. Individual tunnel centres shown on three-dimensional computed tomography reconstructed image (blue dots = group 1, grey dots = group 2, black circle = anatomical centre)

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Source: PubMed

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