Department of Orthopaedic Surgery, University of Florence, Florence, Italy.
J Knee Surg. 2024 Sep;37(11):804-811. doi: 10.1055/a-2315-7873. Epub 2024 Apr 27.
Revision anterior cruciate ligament reconstruction (ACLR) is a challenging surgery occurring in 3 to 24% of primary reconstructions. A meticulous planning to study the precise size and location of both femoral and tibial bone tunnels is mandatory. The aim of the study was to evaluate the intra- and interoperator differences in the decision-making process between experienced surgeons after they were asked to make preoperative planning for ACL revision reconstruction with the use of both the computed tomography (CT) scan and a three-dimensional (3D)-printed model of the knee. Data collected from 23 consecutive patients undergoing revision of ACLR for graft failure at a single institute between September 2018 and February 2020 were prospectively reviewed. The double-blinded collected data were presented to three board-certificate attending surgeons. Surgeons were asked to decide whether to perform one-stage or two-stage revision ACLR based on the evaluation of the CT scan images and the 3D-printed custom-made models at two different rounds, T0 and T1, respectively, 7 days apart one from the other. Interoperator consensus following technical mistake was 52% at T0 and 56% at T1 using the CT scans, meanwhile concordance was 95% at T0 and 94% at T1 using the 3D models. Concordance between surgeons following new knee injury was 66% at T0 and 70% at T1 using CT scans, while concordance was 96% both at T0 and T1 using 3D models. Intraoperative variability using 3D models was extremely low: concordance at T0 and T1 was 98%. McNemar test showed a statistical significance in the use of 3D model for preoperative planning ( < 0.005). 3D-printed model reliability resulted to be higher compared with CT as intraoperator surgery technique selection was not modified throughout time from T0 to T1 ( < 0.005). The use of 3D-printed models had the most impact when evaluating femoral and tibial tunnels, resulting to be a useful instrument during preoperative planning of revision ACLR between attending surgeons with medium-high workflow.
前交叉韧带重建（ACL）翻修术是一种具有挑战性的手术，在初次重建中发生率为 3%~24%。需要进行细致的规划，以研究股骨和胫骨骨隧道的确切大小和位置。本研究旨在评估在经验丰富的外科医生中，在使用计算机断层扫描（CT）和膝关节三维（3D）打印模型进行 ACL 翻修重建术前规划时，手术者间和术者内决策过程的差异。该研究前瞻性地回顾了 2018 年 9 月至 2020 年 2 月期间在一家机构因移植物失败而行 ACL 翻修重建的 23 例连续患者的数据。收集的数据采用双盲法，并分别在两轮（T0 和 T1）呈现给 3 位具有董事会认证的主治外科医生，每轮间隔 7 天。使用 CT 扫描图像和 3D 打印定制模型分别在 T0 和 T1 对同一组数据进行评估，外科医生根据评估结果决定是否行一期或二期翻修 ACLR。使用 CT 扫描时，T0 和 T1 的术者间一致性分别为 52%和 56%，而使用 3D 模型时，T0 和 T1 的一致性分别为 95%和 94%。T0 和 T1 时，在有新膝关节损伤的情况下，使用 CT 扫描的外科医生间一致性分别为 66%和 70%，而使用 3D 模型时，一致性分别为 96%和 96%。使用 3D 模型的术中变异性极低：T0 和 T1 的一致性为 98%。McNemar 检验表明，术前规划中使用 3D 模型具有统计学意义（<0.005）。与 CT 相比，3D 打印模型的可靠性更高，因为从 T0 到 T1，手术者的手术技术选择并未随时间而改变（<0.005）。在评估股骨和胫骨隧道时，3D 打印模型的影响最大，是具有中高工作流程的主治外科医生进行 ACL 翻修术前规划的有用工具。
