Abstract
Background:Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel.Methods:The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service.Results:Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI (p=0.344, p=0.189, p=0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction.Conclusion:This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.
Highlights
Anterior cruciate ligament (ACL) reconstruction has repeatedly demonstrated successful outcomes at short term follow-up
This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction
It aims to improve the stability of the knee, facilitate return to sports and may help prevent osteoarthritis produced in ACL deficient knees [1 - 3]
Summary
Anterior cruciate ligament (ACL) reconstruction has repeatedly demonstrated successful outcomes at short term follow-up. It aims to improve the stability of the knee, facilitate return to sports and may help prevent osteoarthritis produced in ACL deficient knees [1 - 3]. Traditional ACL reconstruction included transtibial drilling of the ACL femoral tunnel, with a focus on isometric graft placement and avoidance of notch impingement [10]. A primary focus towards anatomic reconstruction has been shown to better restore anterior translational as well as rotational stability to an ACL deficient knee [18 - 21]. Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel
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