Femoral offset guide facilitates accurate and precise femoral tunnel placement for single-bundle anterior cruciate ligament reconstruction.

Abstract

The purpose of this study was to compare the accuracy and precision of femoral tunnel placement by expert and novice surgeons using an offset guide for single-bundle ACL reconstruction via the anteromedial (AM) portal. Twenty-five single-bundle ACL reconstructions performed by a novice surgeon were matched with 25 ACL reconstructions performed by an expert surgeon, based on one-to-one propensity score matching. The same technique was used by both groups for femoral tunnel placement using a 7-mm offset guide through the AM portal. Using the Bernard and Hertel grid method for postoperative three-dimensional reconstructed computed tomography, the accuracy and precision of various tunnel positions were compared. No differences were found between the proximal-distal and anterior-posterior femoral tunnel placements by the two groups (proximal-distal; 30.5% involving experts, and 32.5% by novices, n.s) (anterior-posterior; 32.6% involving experts, and 31.6% by novice, n.s). The accuracy of the femoral tunnel positions, based on the average distance from the tunnel center to the center of ACL direct insertion, was similar between the two groups (n.s). No differences were found between the groups in terms of precision of femoral tunnel positions (n.s). Novice surgeons can achieve accuracy and precision comparable to experts in creating femoral tunnels via single-bundle ACL reconstruction through the AM portal using a femoral offset guide. We recommend the use of a femoral offset guide for ACL reconstruction during the learning phase of a novice surgeon for effective tunnel placement to reduce the learning curve required to perform accurate and reproducible ACL reconstruction. Case-control study, Level III.