Summary

This study evaluates the accuracy of femoral tunnel placement using the Anatomic Double-bundle 2-in-1 ACL Guide System in ACL double-bundle reconstruction, demonstrating an 86% hit rate in achieving anatomical positions, with no instances of tunnel coalition, suggesting enhanced surgical precision and consistent postoperative outcomes.

Abstract

Background

Accurate femoral tunnel positioning is crucial in ACL double-bundle reconstruction as it significantly affects postoperative outcomes. Slight deviations from the anatomical position or coalition of the tunnels can lead to graft laxity and reduced knee function. The Anatomic Double-bundle 2-in-1 ACL Guide System was developed to improve the precision of tunnel placement in the constrained space of the femoral condyle and to prevent tunnel coalition, aiming to enhance surgical success.

Objective

The purpose of this study is to evaluate the accuracy of femoral tunnel positioning using the Anatomic Double-bundle 2-in-1 ACL Guide System and to assess whether the tunnel positions correspond to the anatomical attachment sites of the ACL.

Methods

This study involved 14 patients (28 femoral tunnels) who underwent ACL double-bundle reconstruction using semitendinosus tendon grafts. The femoral tunnels were created using the pinpoint guide system on the femoral side. Postoperative femoral tunnel positions were evaluated using 3D CT imaging and analyzed based on the quadrant method. The positions were compared to previously reported data on normal ACL attachment sites, and the hit rate of the guide pin in achieving the optimal position was also assessed.

Results

The analysis of postoperative tunnel positions revealed that the AM (anteromedial) tunnel was located at a height of 21% and a depth of 23%, while the PL (posterolateral) tunnel was at a height of 45% and a depth of 33%. The majority of these tunnels were closely aligned with the reported normal ACL attachment sites, with a hit rate of 86%. Additionally, no cases of tunnel coalition were observed across all cases.

Conclusion

The Anatomic Double-bundle 2-in-1 ACL Guide System demonstrated high accuracy in femoral tunnel placement during ACL double-bundle reconstruction, achieving tunnel positions that closely match the anatomical attachment sites. The system’s ability to prevent tunnel coalition and the 86% hit rate highlight its potential to contribute to consistent postoperative outcomes and improved knee function. These findings suggest that the Anatomic Double-bundle 2-in-1 ACL Guide System may be a valuable tool in enhancing the precision and effectiveness of ACL double-bundle reconstruction. Further studies with larger sample sizes are recommended to validate these results and to explore the long-term benefits of this guide system in clinical practice.