Abstract
PurposeThe goal of this preliminary report was to show the use of novel Ultrasound (US) technology for anterior cruciate ligament (ACL) reconstruction surgery and evaluate its feasibility for the creation of a rectangular femoral bone tunnel during an arthroscopic procedure in a human cadaver model.MethodsTwo fresh frozen human cadaver knees were prepared for arthroscopic rectangular femoral tunnel completion using a prototype US device (OLYMPUS EUROPA SE & CO. KG). The desired rectangular femoral tunnel was intended to be located in the femoral anatomical ACL footprint. Its tunnel aperture was planned at 10 × 5 mm and a depth of 20 mm should be achieved. For one knee, the rectangular femoral tunnel was realized without a specific cutting guide and for the other with a 10 × 5 mm guide. One experienced orthopedic surgeon performed the two procedures consecutively. The time for femoral tunnel completion was evaluated. CT scans with subsequent three-dimensional image reconstructions were performed in order to evaluate tunnel placement and configuration.ResultsIn the two human cadaver models the two 10 × 5x20mm rectangular femoral tunnels were successfully completed and located in the femoral anatomical ACL footprint without adverse events. The time for femoral tunnel completion was 14 min 35 s for the procedure without the guide and 4 min 20 s with the guide.ConclusionUS technology can be used for the creation of a rectangular femoral bone tunnel during an arthroscopic ACL reconstruction procedure. The use of a specific cutting guide can reduce the time for femoral tunnel completion. Additional experience will further reduce the time of the procedure.
Highlights
Ultrasound (US) technology has been used for nearly 3 decades in surgery for cutting and coagulation of soft tissues [1, 3]
Tests on human cadaver model In the two human cadaver models, 10 × 5x20mm femoral tunnels were successfully completed without adverse events under usual arthroscopic conditions (Fig. 4)
CT scans with three-dimensional image reconstructions analyses demonstrated that in both cases femoral tunnels was located in the femoral anatomical anterior cruciate ligament (ACL) footprint, behind the Resident’s ridge (Fig. 5)
Summary
Ultrasound (US) technology has been used for nearly 3 decades in surgery for cutting and coagulation of soft tissues [1, 3] This technology has shown to be efficient for bony procedures in dentistry [34]. For anterior cruciate ligament (ACL) reconstructions, recent efforts from Japan and Europe have intended to reproduce the anatomy of the femoral ACL insertion site by using a rectangular-shaped tunnel [6, 12, 18, 26, 27]. This allows to place the tunnel aperture into the ACL footprint and reproduce the anatomy of the native ACL and its fiber insertions.
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