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. 2024 Jan;144(1):289-296.
doi: 10.1007/s00402-023-05072-w. Epub 2023 Sep 29.

Patient specific instrumentation in ACL reconstruction: a proof-of-concept cadaver experiment assessing drilling accuracy when using 3D printed guides

Mark J M Zee  1 , Peter A J Pijpker  2 , Joep Kraeima  3 , Alain R Viddeleer  4 , Ronald L Diercks  5
Affiliations

Patient specific instrumentation in ACL reconstruction: a proof-of-concept cadaver experiment assessing drilling accuracy when using 3D printed guides

Mark J M Zee et al. Arch Orthop Trauma Surg. 2024 Jan.

Abstract

Introduction: Accurate positioning of the femoral tunnel in ACL reconstruction is of the utmost importance to reduce the risk of graft failure. Limited visibility during arthroscopy and a wide anatomical variance attribute to femoral tunnel malposition using conventional surgical techniques. The purpose of this study was to determine whether a patient specific 3D printed surgical guide allows for in vitro femoral tunnel positioning within 2 mm of the planned tunnel position.

Materials and methods: A patient specific guide for femoral tunnel positioning in ACL reconstruction was created for four human cadaveric knee specimens based on routine clinical MRI data. Fitting properties were judged by two orthopedic surgeons. MRI scanning was performed both pre- and post-procedure. The planned tunnel endpoint was compared to the actual drilled femoral tunnel.

Results: This patient specific 3D printed guide showed a mean deviation of 5.0 mm from the center of the planned femoral ACL origin.

Conclusion: In search to improve accuracy and consistency of femoral tunnel positioning in ACL reconstruction, the use of a patient specific 3D printed surgical guide is a viable option to explore further. The results are comparable to those of conventional techniques; however, further design improvements are necessary to improve accuracy and enhance reproducibility.

Keywords: ACL reconstruction; Anatomic; Femoral tunnel; Patient specific instrument.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Example of sagittal view of a 3D MRI. The center of the femoral origin of the ACL was determined and marked by a red circle of 2 mm in diameter
Fig. 2
Fig. 2
Images displaying a sagittal (left) and cranial (right) view of a 3D model of a distal femur with the cone described by Kang et al. projected in place
Fig. 3
Fig. 3
The patient specific 3D printed femoral aiming guide. a The drill trajectory aims for the pre-determined ACL origin b the aiming device fits the medial wall of the lateral femoral condyle anatomically (detailed view). c Inventory kit with four 3D printed PSI aiming guides. d Example of the 3D printed aiming guide in situ
Fig. 4
Fig. 4
Example of comparison planned and drilled tunnels. Drilled tunnel is displayed in red. Planned tunnel in dark-gray. a Anterior Posterior view. b Sagittal view. c Caudo-cranial view. d Notch view
See this image and copyright information in PMC

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