Effectiveness of anterior cruciate ligament reconstruction with personalized femoral locator based on apex of deep cartilage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Renjie , NING Ziwen , GU Ziming , SHI Zhengliang , XIANG Yaoyu , WANG Guoliang , LI Yanlin ,  HE Chuan

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

HE Chuan, Email: hczraul@sina.com

Keywords：

Knee joint; anterior cruciate ligament; apex of deep cartilage; personalized femoral locator

DOI：

10.7507/1002-1892.202303012

Video：

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Objective To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral locator based on the apex of deep cartilage (ADC) combined with patient imaging data. Methods Between January 2021 and January 2022, a total of 40 patients with primary ACL rupture were selected and randomly divided into study group (ACL reconstruction assisted by personalized femoral locator based on ADC) and control group (ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator), with 20 cases in each group. There was no significant difference in gender, age, body mass index, affected side, cause of injury, and preoperative International Knee Documentation Committee (IKDC) score, Lyshlom score, and Tegner score between the two groups (P>0.05). IKDC score, Lyshlom score, and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3, 6, and 12 months after operation. CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin (L) and the horizontal distance from ADC to the center of the femoral canal (I), and the anteroposterior position of the bone canal (R) was calculated by I/L; the distance from the center to the distal cartilage margin (D) was measured on the two-dimensional cross section; the R value and D value were compared between the two groups. Results The operation time of the study group was significantly less than that of the control group [MD=?6.90 (?8.78, ?5.03), P<0.001]. The incisions of the two groups healed by first intention, and no complication such as intra-articular infection, nerve injury, and deep vein thrombosis of lower limbs occurred. There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group [MD=0.52 (?2.85, 3.88), P=0.758; MD=0.36 (?0.39, 1.11), P=0.351]. There was no significant difference in the actual intraoperative positioning R value and D value between the study group and the control group [MD=1.01 (?2.57, 4.58), P=0.573; MD=0.24 (?0.34, 0.82), P=0.411]. The patients in both groups were followed up 12-13 months (mean, 12.4 months). The IKDC score, Lysholm score, and Tegner score of the two groups increased gradually with time, and there were significant differences between pre- and post-operation (P<0.05). There was no significant difference in the scores between the two groups at each time point after operation (P>0.05). Conclusion The personalized femoral locator based on ADC can accurately assist the femoral tunnel positioning in ACL reconstruction, which can shorten the operation time when compared with traditional surgical methods, and achieve satisfactory early effectiveness.

Citation： HE Renjie, NING Ziwen, GU Ziming, SHI Zhengliang, XIANG Yaoyu, WANG Guoliang, LI Yanlin, HE Chuan. Effectiveness of anterior cruciate ligament reconstruction with personalized femoral locator based on apex of deep cartilage. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 833-838. doi: 10.7507/1002-1892.202303012 Copy

1.	Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J Med, 2008, 359(20): 2135-2142.
2.	Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician, 2010, 82(8): 917-922.
3.	Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med, 2019, 380(24): 2341-2348.
4.	Tay KS, Tan AHC. Clinical outcomes, return to sports, and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an Asian population-A 2-year follow-up study. Arthroscopy, 2018, 34(4): 1054-1059.
5.	Jaecker V, Zapf T, Naendrup JH, et al. High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques. Arch Orthop Trauma Surg, 2017, 137(9): 1293-1299.
6.	Robinson J, Inderhaug E, Harlem T, et al. Anterior cruciate ligament femoral tunnel placement: An analysis of the intended versus achieved position for 221 international high-volume ACL surgeons. Am J Sports Med, 2020, 48(5): 1088-1099.
7.	何任杰, 寧梓文, 施政良, 等. 個性化股骨定位器輔助前交叉韌帶重建術后膝關節三維運動學分析. 中國修復重建外科雜志, 2023, 37(6): 663-669.
8.	Rahardja R, Zhu M, Love H, et al. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee, 2020, 27(2): 287-299.
9.	Siebold R. The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2011, 19(5): 699-706.
10.	Kondo E, Merican AM, Yasuda K, et al. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med, 2011, 39(2): 279-288.
11.	Balasingam S, Karikis I, Rostg?rd-Christensen L, et al. Anatomic double-bundle anterior cruciate ligament reconstruction is not superior to anatomic single-bundle reconstruction at 10-year follow-up: A randomized clinical trial. Am J Sports Med, 2022, 50(13): 3477-3486.
12.	Iwahashi T, Shino K, Nakata K, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy, 2010, 26(9 Suppl): S13-S20.
13.	Nawabi DH, Tucker S, Schafer KA, et al. ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med, 2016, 44(10): 2563-2571.
14.	Pearle AD, Mcallister D, Howell SM. Rationale for strategic graft placement in anterior cruciate ligament reconstruction: I. D. E. A. L. femoral tunnel position. Am J Orthop (Belle Mead NJ), 2015, 44(6): 253-258.
15.	Su C, Kuang SD, Liu WJ, et al. Clinical outcome of remnant-preserving and I. D. E. A. L. femoral tunnel technique for anterior cruciate ligament reconstruction. Orthop Surg, 2020, 12(6): 1693-1702.
16.	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. Arthroscopy, 2015, 31(9): 1777-1783.
17.	Domnick C, Herbort M, Raschke MJ, et al. Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique, whereas medial-portal-aiming devices with larger offset hit the center reliably. Arch Orthop Trauma Surg, 2016, 136(4): 499-504.
18.	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, 2018, 26(2): 468-477.
19.	馬勇, 王海軍, 蔣艷芳, 等. 髁間窩外側壁后軟骨緣頂點在評估前交叉韌帶股骨骨道位置中的臨床應用. 中國運動醫學雜志, 2016, 35(10): 925-929.
20.	陳廣超, 何川, 張振光, 等. 3D打印脛骨隧道定位模板在膝關節前交叉韌帶重建術中的準確性研究. 中華創傷骨科雜志, 2019, 21(9): 790-795.
21.	Stirling P, Valsalan Mannambeth R, Soler A, et al. Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty. World J Orthop, 2015, 6(2): 290-297.
22.	Bernard M, Hertel P, Hornung H, et al. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg, 1997, 10(1): 14-22.
23.	de Abreu-e-Silva GM, Baumfeld DS, Bueno EL, et al. Clinical and three-dimensional computed tomographic comparison between ACL transportal versus ACL transtibial single-bundle reconstructions with hamstrings. Knee, 2014, 21(6): 1203-1209.
24.	Youm YS, Cho SD, Lee SH, et al. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med, 2014, 42(12): 2941-2947.

1. Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J Med, 2008, 359(20): 2135-2142.
2. Cimino F, Volk BS, Setter D. Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician, 2010, 82(8): 917-922.
3. Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med, 2019, 380(24): 2341-2348.
4. Tay KS, Tan AHC. Clinical outcomes, return to sports, and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an Asian population-A 2-year follow-up study. Arthroscopy, 2018, 34(4): 1054-1059.
5. Jaecker V, Zapf T, Naendrup JH, et al. High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques. Arch Orthop Trauma Surg, 2017, 137(9): 1293-1299.
6. Robinson J, Inderhaug E, Harlem T, et al. Anterior cruciate ligament femoral tunnel placement: An analysis of the intended versus achieved position for 221 international high-volume ACL surgeons. Am J Sports Med, 2020, 48(5): 1088-1099.
7. 何任杰, 寧梓文, 施政良, 等. 個性化股骨定位器輔助前交叉韌帶重建術后膝關節三維運動學分析. 中國修復重建外科雜志, 2023, 37(6): 663-669.
8. Rahardja R, Zhu M, Love H, et al. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee, 2020, 27(2): 287-299.
9. Siebold R. The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2011, 19(5): 699-706.
10. Kondo E, Merican AM, Yasuda K, et al. Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med, 2011, 39(2): 279-288.
11. Balasingam S, Karikis I, Rostg?rd-Christensen L, et al. Anatomic double-bundle anterior cruciate ligament reconstruction is not superior to anatomic single-bundle reconstruction at 10-year follow-up: A randomized clinical trial. Am J Sports Med, 2022, 50(13): 3477-3486.
12. Iwahashi T, Shino K, Nakata K, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy, 2010, 26(9 Suppl): S13-S20.
13. Nawabi DH, Tucker S, Schafer KA, et al. ACL fibers near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med, 2016, 44(10): 2563-2571.
14. Pearle AD, Mcallister D, Howell SM. Rationale for strategic graft placement in anterior cruciate ligament reconstruction: I. D. E. A. L. femoral tunnel position. Am J Orthop (Belle Mead NJ), 2015, 44(6): 253-258.
15. Su C, Kuang SD, Liu WJ, et al. Clinical outcome of remnant-preserving and I. D. E. A. L. femoral tunnel technique for anterior cruciate ligament reconstruction. Orthop Surg, 2020, 12(6): 1693-1702.
16. 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. Arthroscopy, 2015, 31(9): 1777-1783.
17. Domnick C, Herbort M, Raschke MJ, et al. Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique, whereas medial-portal-aiming devices with larger offset hit the center reliably. Arch Orthop Trauma Surg, 2016, 136(4): 499-504.
18. 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, 2018, 26(2): 468-477.
19. 馬勇, 王海軍, 蔣艷芳, 等. 髁間窩外側壁后軟骨緣頂點在評估前交叉韌帶股骨骨道位置中的臨床應用. 中國運動醫學雜志, 2016, 35(10): 925-929.
20. 陳廣超, 何川, 張振光, 等. 3D打印脛骨隧道定位模板在膝關節前交叉韌帶重建術中的準確性研究. 中華創傷骨科雜志, 2019, 21(9): 790-795.
21. Stirling P, Valsalan Mannambeth R, Soler A, et al. Computerised tomography vs magnetic resonance imaging for modeling of patient-specific instrumentation in total knee arthroplasty. World J Orthop, 2015, 6(2): 290-297.
22. Bernard M, Hertel P, Hornung H, et al. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg, 1997, 10(1): 14-22.
23. de Abreu-e-Silva GM, Baumfeld DS, Bueno EL, et al. Clinical and three-dimensional computed tomographic comparison between ACL transportal versus ACL transtibial single-bundle reconstructions with hamstrings. Knee, 2014, 21(6): 1203-1209.
24. Youm YS, Cho SD, Lee SH, et al. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med, 2014, 42(12): 2941-2947.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of anterior cruciate ligament reconstruction with personalized femoral locator based on apex of deep cartilage

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