ISAKOS Congress 2021

2021 ISAKOS Biennial Congress ePoster


Patient Specific Instrumentation In Acl Reconstruction. A Novel Technique Using A 3D Printed Guide.

Mark Zee, MD, Zwolle NETHERLANDS
Joep Kraeima, PhD, Groningen NETHERLANDS
Alain Viddeleer, MD, PhD, Groningen NETHERLANDS
Ronald L. Diercks, Prof, MD, PhD, Groningen, Groningen NETHERLANDS

University Medical Center Groningen, Groningen, NETHERLANDS

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Arthrex, GrafLink


Patient specific instrumentation in ACL reconstruction shows promising results in vitro.

ePosters will be available shortly before Congress



In young active patients who have suffered a rupture of the anterior cruciate ligament (ACL), ACL reconstruction is the cornerstone of treatment. Current techniques are designed to reconstruct the ACL in an anatomic position. Non anatomic placement of the ACL graft leads to increased risk of failure of the graft. Failure of reconstruction occurs in 0-14% of primary ACL reconstructions. In up to 54% of cases, technical failure is an additive cause for failure. In 80% of technical failures, malposition of the femoral tunnel is the issue. Current surgical techniques with universal guides leading the direction for tunnels seem to come short in providing a constant and reliable result for creating a femoral tunnel at the individual anatomic origin of the ACL. The need for a patient specific drill guide for femoral tunnel placement seems apparent.


To determine the in vitro accuracy of a patient specific 3D printed surgical guide, to be used for femoral tunnel positioning in ACL reconstruction.


A patient specific guide for femoral tunnel positioning in ACL reconstruction was created for 4 human cadaveric knee specimens based on both routine clinical MRI and 3D MRI. Molds were created in 100%, 1mm larger and 1 mm smaller than the original. Printing accuracy was assessed. Fitting properties were judged by two orthopaedic surgeons. MRI scanning was performed both pre- and post-procedure. The planned trajectory was compared to the actual drilled trajectory.


High printing accuracy was achieved with a deviation of 0.1-0.3 mm (SD 0.12-0.14mm). Molds based on routine clinical MRI with an enlargement of +1mm were judged to fit best. The patient specific 3D printed guide proved to be very accurate with a deviation of 1.5 mm from the intended tunnel location.


Usage of a patient specific 3D printed surgical guide for femoral tunnel placement in ACL reconstruction seems promising. Using this novel instrument, femoral tunnel placement in ACL reconstruction may become more accurate and consistent, especially in low volume surgeons.

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