Anatomical evaluation of the positions of bone tunnels created using a rectangular retro-dilator in revision anterior...

This study used three-dimensional computed tomography (3D-CT) to evaluate the targeted positions of rectangular bone tunnels created using a rectangular retro-dilator (RRD) in revision anterior cruciate ligament (ACL) reconstruction, with the aim of assessing the accuracy of the technique in bone tunnel creation at the target position.

Participants were 30 patients who underwent revision ACL reconstruction using an RRD. Based on 3D-CT images, the positions of the primary and revision tunnels were qualitatively evaluated according to the Magnussen classification, the quadrant method, and whether they were in the anatomical tibial attachment site of the ACL. Furthermore, coordinate data obtained by the quadrant method for the positions of the primary and revision tunnels were compared with anatomical and targeted ligament attachment sites.

All femoral revision tunnels were Type I according to the Magnussen classification. Qualitative evaluation of the tibial tunnels showed that the tunnel centres fell within the anatomical ACL attachment site in all patients. The femoral and tibial tunnel positions did not significantly differ from the targeted position, and both variances in the positions of the revision tunnels were significantly smaller than those of the primary tunnels.

The findings suggest that use of an RRD can create rectangular tunnels at the targeted position with a high rate of success in revision. In this study, the revision ACL reconstruction using an RRD allowed more anatomical positioning of bone tunnels than the primary reconstruction.