Identification of Anterior Cruciate Ligament Tunnel Drilling Technique Using X-Ray

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Texas Ortho J


Introduction: erior cruciate ligament (ACL) reconstruction is commonly performed and surgeons use different techniques to drill the femoral tunnel. Failed ACL reconstruction is most frequently due to tunnel malposition. The ability to identify which tunnel drilling technique was used is important in revision situations. The purpose of our study was to evaluate the utility of radiographs in differentiating between femoral tunnels drilled through the anteromedial portal or the transtibial tunnel.

Methods: Radiographs from 40 patients (20 transtibial tunnel technique and 20 anteromedial portal technique) were presented to 8 different reviewers (4 orthopaedic faculty and 4 trainees), at two separate occasions. We evaluated the overall number of times the correct technique was identified, as well as compared the accuracy of the observers’ first and second attempts. The accuracy of faculty surgeons was compared to that of trainees.

Results: The correct technique was identified 591/640 (92.3%) times. There was no difference between the accuracy of faculty members and trainees in identifying the correct technique (93.4% vs 91.2%, respectively. There was no difference in accuracy between the first and second trials (92.5% and 92.2%, respectively). Intraobserver agreement was high, at 92.8% for all trials. 34 of 40 (85%) of radiographs were identified correctly on at least 6/8 attempts.

Discussion: Radiographs are a useful tool in distinguishing between femoral tunnels drilled using the transtibial tunnel and anteromedial portal in ACL reconstruction. Faculty and trainees alike are highly accurate in identifying the technique utilized. When the radiographs are unclear, repeat radiographs or additional axial imaging may be necessary in planning revision ACL reconstruction.

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School of Medicine

Primary Department

Orthopedic Surgery

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