Is intraoperative fluoroscopy necessary in anterior cruciate ligament double-bundle reconstruction? A prospective randomized controlled trial

Abstract

IntroductionProperly placed tibial and femoral tunnels in anterior cruciate ligament (ACL) reconstruction are important because tunnel misplacement can cause abnormal changes in graft tension patterns, resulting in postoperative knee laxity. To overcome the inaccuracy of tunnel position in ACL reconstruction, intraoperative fluoroscopy has been proven to be a useful method in previous studies focusing on the tunnel position in single-bundle reconstruction, but few studies are available on the efficacy and necessity of intraoperative fluoroscopy for double-bundle (DB) reconstruction. The purpose of this prospective randomized case-control study was to evaluate the effect of intraoperative fluoroscopy on femoral and tibial tunnel position in anatomic DB ACL reconstruction using a postoperative tunnel position in a three-dimensional computed tomography (3D-CT). HypothesisIntraoperative fluoroscopy during ACL DB reconstruction could make an appropriate tunnel position closer to the anatomical center compared to conventional fluoroscopy-free procedure. Material and methodsSixty patients undergoing ACL DB reconstruction (30 fluoroscopy-free reconstruction group and 30 in fluoroscopy-assisted reconstruction group) were included in this prospective study, and randomly allocated into two groups. Mean values of the percentage distance of femoral and tibial tunnel center in a 3D-CT were compared between the two groups. Knee laxity (the anterior translation and pivot-shift grade) and clinical outcomes were also compared at the last follow-up. ResultsThere was a significant difference only in femoral anteromedial (AM) bundle tunnel position, but not in femoral posterolateral (PL) bundle, tibial AM, or PL bundle tunnel position between the two groups. Femoral AM bundle tunnel in the fluoroscopy-assisted reconstruction group showed significantly (p=0.005) deeper position compared to that in the fluoroscopy-free reconstruction group. There was no significant difference in anterior translation, pivot-shift grade, or clinical outcomes between the two groups. DiscussionFluoroscopy-assisted ACL DB reconstruction can make deeper placement of the femoral AM bundle than the conventional ACL DB reconstruction. Level of evidenceII, prospective randomized controlled trial.