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Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

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Arthroscopic Viewing Position Affects Anterior Cruciate Ligament Reconstruction Femoral Tunnel Length Measurements

Sheeba M Joseph et al. Front Surg.

Abstract

Purpose: To purpose of this study was to compare arthroscopic anterior cruciate ligament (ACL) reconstruction femoral tunnel length measurements from the anterolateral portal between the standard notch view using a 30° arthroscope versus a "top-down" view utilizing a 70° arthroscope to visual the far side of the femoral tunnel aperture.

Methods: Arthroscopic femoral tunnel length measurements using calibrated reamers from the standard notch versus the "top-down" view were obtained and reviewed in 54 skeletally mature patients undergoing ACL reconstruction with no prior bony knee surgery. Patient age, height, weight, sex, and surgery laterality were also recorded. Measurements of femoral tunnel length were repeated using both views for inter-observer and intra-observer correlation.

Results: Inter-observer and intra-observer intra-class correlation coefficients for the standard notch view and "top-down" views were excellent, with higher reliability values appreciated using the "top down" view. Mean overall femoral tunnel length measurements obtained using the standard notch view were significantly longer than measurements from the "top-down" view (p < 0.001).

Conclusions: The standard notch view provides significantly longer femoral tunnel length measurements in comparison to the "top-down" view.

Keywords: ACL reconstruction; arthroscopy; femoral tunnel length; graft-tunnel mismatch; seventy-degree arthroscopy.

Figures

Figure 1
Figure 1
Arthroscopic images of a left knee during femoral tunnel reaming to obtain femoral tunnel reamer measurements. (A) Standard notch view (B) Surgeon hand and camera position for obtaining standard notch view (C) Top-down view (D) Surgeon hand and camera position for obtaining top-down view.
Figure 2
Figure 2
Digital caliper measurement of flexible reamer links and gaps for femoral tunnel length measurements.
Figure 3
Figure 3
Comparison of femoral tunnel length measurements obtained by the standard notch view and the top-down view.
Figure 4
Figure 4
Box plots of femoral tunnel length measurements in millimeters by arthroscopic technique. Upper and lower hinges represent 25 and 75% quartiles; middle represent median or 50% quartile.

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