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Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.

Publication ,  Journal Article
Wolf, BR; Ramme, AJ; Wright, RW; Brophy, RH; McCarty, EC; Vidal, AR; Parker, RD; Andrish, JT; Amendola, A; MOON Knee Group
Published in: Am J Sports Med
June 2013

BACKGROUND: Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/ HYPOTHESIS: The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. RESULTS: For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. CONCLUSION: The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth, likely reflecting the difference in individual surgeons' preferred tunnel locations. Individual surgeons are relatively consistent in their cases of ACL tunnels.

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Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

June 2013

Volume

41

Issue

6

Start / End Page

1265 / 1273

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Tibia
  • Practice Patterns, Physicians'
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Joint
  • Imaging, Three-Dimensional
 

Citation

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Wolf, B. R., Ramme, A. J., Wright, R. W., Brophy, R. H., McCarty, E. C., Vidal, A. R., … MOON Knee Group. (2013). Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability. Am J Sports Med, 41(6), 1265–1273. https://doi.org/10.1177/0363546513483271
Wolf, Brian R., Austin J. Ramme, Rick W. Wright, Robert H. Brophy, Eric C. McCarty, Armando R. Vidal, Richard D. Parker, Jack T. Andrish, Annunziato Amendola, and MOON Knee Group. “Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.Am J Sports Med 41, no. 6 (June 2013): 1265–73. https://doi.org/10.1177/0363546513483271.
Wolf BR, Ramme AJ, Wright RW, Brophy RH, McCarty EC, Vidal AR, et al. Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability. Am J Sports Med. 2013 Jun;41(6):1265–73.
Wolf, Brian R., et al. “Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.Am J Sports Med, vol. 41, no. 6, June 2013, pp. 1265–73. Pubmed, doi:10.1177/0363546513483271.
Wolf BR, Ramme AJ, Wright RW, Brophy RH, McCarty EC, Vidal AR, Parker RD, Andrish JT, Amendola A, MOON Knee Group. Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability. Am J Sports Med. 2013 Jun;41(6):1265–1273.
Journal cover image

Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

June 2013

Volume

41

Issue

6

Start / End Page

1265 / 1273

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Tomography, X-Ray Computed
  • Tibia
  • Practice Patterns, Physicians'
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Joint
  • Imaging, Three-Dimensional