Orthopaedic Clinic, University of Florence, Largo P. Palagi 1, 50139, Florence, Italy.
Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):468-477. doi: 10.1007/s00167-017-4614-7. Epub 2017 Jun 19.
To evaluate the feedback from post-operative three-dimensional computed tomography (3D-CT) on femoral tunnel placement in the learning process, to obtain an anatomic anterior cruciate ligament (ACL) reconstruction.
A series of 60 consecutive patients undergoing primary ACL reconstruction using autologous hamstrings single-bundle outside-in technique were prospectively included in the study. ACL reconstructions were performed by the same trainee-surgeon during his learning phase of anatomic ACL femoral tunnel placement. A CT scan with dedicated tunnel study was performed in all patients within 48 h after surgery. The data obtained from the CT scan were processed into a three-dimensional surface model, and a true medial view of the lateral femoral condyle was used for the femoral tunnel placement analysis. Two independent examiners analysed the tunnel placements. The centre of femoral tunnel was measured using a quadrant method as described by Bernard and Hertel. The coordinates measured were compared with anatomic coordinates values described in the literature [deep-to-shallow distance (X-axis) 28.5%; high-to-low distance (Y-axis) 35.2%]. Tunnel placement was evaluated in terms of accuracy and precision. After each ACL reconstruction, results were shown to the surgeon to receive an instant feedback in order to achieve accurate correction and improve tunnel placement for the next surgery. Complications and arthroscopic time were also recorded.
Results were divided into three consecutive series (1, 2, 3) of 20 patients each. A trend to placing femoral tunnel slightly shallow in deep-to-shallow distance and slightly high in high-to-low distance was observed in the first and the second series. A progressive improvement in tunnel position was recorded from the first to second series and from the second to the third series. Both accuracy (+52.4%) and precision (+55.7%) increased from the first to the third series (p < 0.001). Arthroscopic time decreased from a mean of 105 min in the first series to 57 min in the third series (p < 0.001). After 50 ACL reconstructions, a satisfactory anatomic femoral tunnel was reached.
Feedback from post-operative 3D-CT is effective in the learning process to improve accuracy and precision of femoral tunnel placement in order to obtain anatomic ACL reconstruction and helps to reduce also arthroscopic time and learning curve. For clinical relevance, trainee-surgeons should use feedback from post-operative 3DCT to learn anatomic ACL femoral tunnel placement and apply it appropriately.
Consecutive case series, Level IV.
评估术后三维 CT（3D-CT）对学习过程中股骨隧道放置的反馈，以获得解剖学前交叉韧带（ACL）重建。
前瞻性纳入 60 例连续接受自体腘绳肌单束外-内技术行初次 ACL 重建的患者。由同一位受训外科医生在解剖学 ACL 股骨隧道放置的学习阶段进行 ACL 重建。所有患者术后 48 小时内行 CT 扫描加专用隧道研究。从 CT 扫描中获取的数据被处理成三维表面模型，并使用外侧股骨髁的真正内侧视图进行股骨隧道放置分析。两位独立的检查者分析了隧道位置。股骨隧道的中心使用 Bernard 和 Hertel 描述的象限法进行测量。所测量的坐标与文献中描述的解剖学坐标值进行比较[深-浅距离（X 轴）28.5%；高-低距离（Y 轴）35.2%]。根据准确性和精密度评估隧道位置。每次 ACL 重建后，将结果展示给外科医生，以便立即获得反馈，从而实现准确的纠正，并改善下一次手术的隧道放置。还记录了并发症和关节镜时间。
结果分为 3 组，每组 20 例，连续进行。在前两个系列中，观察到股骨隧道在深-浅距离上稍微浅，在高-低距离上稍微高的趋势。从第一个系列到第二个系列，再从第二个系列到第三个系列，隧道位置都得到了逐步改善。从第一个系列到第三个系列，准确性（+52.4%）和精密度（+55.7%）均增加（p<0.001）。关节镜时间从第一个系列的平均 105 分钟减少到第三个系列的 57 分钟（p<0.001）。在进行了 50 次 ACL 重建后，达到了满意的解剖学股骨隧道。
术后 3D-CT 的反馈在学习过程中是有效的，可以提高股骨隧道放置的准确性和精密度，以获得解剖学 ACL 重建，并有助于减少关节镜时间和学习曲线。从临床相关性来看，受训外科医生应该使用术后 3D-CT 的反馈来学习解剖学 ACL 股骨隧道放置，并适当地应用它。
连续病例系列，IV 级。
