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Computer Patient-Specific 3D Modeling and Custom-Made Guides for Revision ACL Surgery
Armando Del Prete1, Piero Franco1, Matteo Innocenti1
1Department of Orthopaedic Surgery, University of Florence, Florence, Italy.
The Journal of Knee Surgery
|April 27, 2024
Summary
Preoperative planning for revision anterior cruciate ligament reconstruction (ACLR) is improved with 3D-printed models. These models enhance surgeon decision-making and reduce variability compared to CT scans for ACLR surgery.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Surgical Planning
Background:
- Revision anterior cruciate ligament reconstruction (ACLR) is a complex procedure with a significant re-operation rate.
- Accurate preoperative planning, particularly for femoral and tibial tunnel placement, is critical for successful revision ACLR.
- Existing methods using computed tomography (CT) scans may have limitations in visualizing complex anatomy for revision cases.
Purpose of the Study:
- To compare the intra- and inter-operator reliability of preoperative planning for revision ACLR using CT scans versus 3D-printed knee models.
- To evaluate surgeon decision-making regarding one-stage versus two-stage revision ACLR based on different imaging modalities.
- To assess the impact of 3D models on surgical planning accuracy and consistency.
Main Methods:
- Prospective review of 23 revision ACLR cases.
- Three experienced surgeons evaluated CT scans and patient-specific 3D-printed knee models in two separate sessions (T0 and T1).
- Surgeons determined the need for one-stage or two-stage revision and assessed tunnel placement, with data analyzed for inter- and intra-operator concordance.
Main Results:
- 3D models significantly improved inter-operator concordance for revision ACLR planning (94-95%) compared to CT scans (52-70%).
- Intra-operator concordance was high with 3D models (98%), indicating consistent decision-making over time.
- 3D models demonstrated superior reliability in evaluating femoral and tibial tunnels, leading to statistically significant improvements in planning (p < 0.005).
Conclusions:
- 3D-printed models enhance the reliability and consistency of preoperative planning for revision ACLR compared to traditional CT scans.
- The use of 3D models reduces inter- and intra-operator variability, aiding surgeons in complex decision-making processes.
- 3D models are a valuable tool for optimizing surgical planning in revision ACLR, particularly for evaluating bone tunnel dimensions and locations.
