Comparison Of Free Hand Versus Offset Guide Technique For Femoral Tunnel Placement In Arthroscopic Anterior Cruciate Ligament Reconstruction
Background: Accurate femoral tunnel placement is one of the most crucial steps of ACL reconstruction, and also a predictor of better outcome. This study was done to compare two methods of femoral tunnel drilling, freehand method and offset guide method and to assess them by 3D CT Scan using Bernhard Hertel quadrant to find out which is better method of tunnel placement.
Material and methods: 30 patients, who underwent arthroscopic ACL reconstruction from June 2018 to April 2020, were compared for the femoral tunnel placement by freehand and offset methods and were assessed by postoperative 3D CT Scan. Height and length of femoral tunnel and the percentage of femoral height (h) and length (t) to the total height and length respectively were calculated on the Bernhard Hertel quadrant and compared.
Results: The mean ‘h’ was 28.62 ± 7.68 (range 15.5 to 42), while mean of ‘t’ was 34.86 ± 9 (range 21.5 to 55.5) in free hand method. The mean ‘h’ was 28.65 ± 10.19 (range 11.6 to 58), while mean of ‘t’ was 31.6 ± 5.02 (range 21.8 to 44.4) in femoral offset guide method. On comparing mean of “h” of freehand method with the mean of “h” of offset guide method, the p value was 0.984 (p value > 0.05), which was not significant. Similarly, on comparing mean of “t” of freehand method with the mean of “t” of offset guide method, the p value was 0.230 (p value > 0.05), which was not significant.
Conclusion: Femoral tunnel preparation leads to almost similar tunnel position by both freehand and offset guide method. Both methods are associated with surgeon’s learning curve. 3D CT-Scan and Bernhard Hertel grid is reliable and reproducible method for evaluating femoral tunnel.
2. Ajuied A, Smith C, Wong F, Hoskinson S, Back D, Davies A. A Survey of Rehabilitation Regimens Following Isolated ACL Reconstruction. J Med Res 2014:1-9.
3. Lobb R, Tumilty S, Claydon LS. A review of systematic reviews on anterior cruciate ligament reconstruction rehabilitation. Phys Ther Sport. 2012 Nov;13(4):270-8.
4. Kim M, Choi YS, Kim H, Choi NH. Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging. Korean J Radiol. 2016 Nov-Dec;17(6):919-30.
5. Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med. 2005 May;33(5):712-8.
6. Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthrosc. 2007 Nov;23(11):1218-25.
7. Tsukada S, Fujishiro H, Watanabe K, Nimura A, Mochizuki T, Mahakkanukrauh P, Yasuda K, Akita K. Anatomic variations of the lateral intercondylar ridge: relationship to the anterior margin of the anterior cruciate ligament. Am J Sports Med. 2014 May;42(5):1110-7.
8. Inderhaug E, Larsen A, Waaler PA, Strand T, Harlem T, Solheim E. The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1211-18.
9. Celentano U, Cardoso MP, Martins CA, Ramirez CP, van Eck CF, Smolinski P, Fu FH. Use of transtibial aimer via the accessory anteromedial portal to identify the center of the ACL footprint. Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):69-74.
10. Hart A, Han Y, Martineau PA. The Apex of the Deep Cartilage: A Landmark and New Technique to Help Identify Femoral Tunnel Placement in Anterior Cruciate Ligament Reconstruction. Arthrosc. 2015 Sep;31(9):1777-83.
11. Fernandes TL, Martins NM, WataiFde A, Albuquerque C Jr, Pedrinelli A, Hernandez AJ. 3D computer tomography for measurement of femoral position in acl reconstruction. Acta Ortop Bras. 2015 Jan-Feb;23(1):11-5.
12. Piefer JW, Pflugner TR, Hwang MD, Lubowitz JH. Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature. Arthrosc. 2012 Jun;28(6):872-81.
13. Kim MS, Koh IJ, Sohn S, Kang BM, Jung H, In Y. Femoral offset guide facilitates accurate and precise femoral tunnel placement for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3505-12.
14. Dutt S, Kumar V. A comparative study of anatomical single-bundle anterior cruciate ligament reconstruction using femoral offset aimer versus freehand technique for femoral tunnel preparation. Eur J OrthopSurgTraumatol. 2020 Apr;30(3):493-9.
15. Tantuway V, Mustafa Johar SA, Patel V, Nagla A, Gupta R, Bhambani P. Assessment of foot print of femoral tunnel placement with commercially available off set guide in arthroscopic ACL reconstruction. Int J Res Orthop 2017;3:43-9.
16. Kawaguchi Y, Kondo E, Takeda R, Akita K, Yasuda K, Amis AA. The role of fibers in the femoral attachment of the anterior cruciate ligament in resisting tibial displacement. Arthrosc. 2015 Mar;31(3):435-44.
Copyright (c) 2021 Orthopaedic Journal of M. P. Chapter
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.