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.
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