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J Knee Surg
DOI: 10.1055/a-2315-7873
Original Article

Computer Patient-Specific 3D Modeling and Custom-Made Guides for Revision ACL Surgery

Armando Del Prete
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Piero Franco
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Matteo Innocenti
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Fabrizio Matassi
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Filippo Leggieri 
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Rosario Jr Sagliocco
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
,
Roberto Civinini
1   Department of Orthopaedic Surgery, University of Florence, Florence, Italy
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Abstract

Revision anterior cruciate ligament reconstruction (ACLR) is a challenging surgery occurring in 3 to 24% of primary reconstructions. A meticulous planning to study the precise size and location of both femoral and tibial bone tunnels is mandatory. The aim of the study was to evaluate the intra- and interoperator differences in the decision-making process between experienced surgeons after they were asked to make preoperative planning for ACL revision reconstruction with the use of both the computed tomography (CT) scan and a three-dimensional (3D)-printed model of the knee. Data collected from 23 consecutive patients undergoing revision of ACLR for graft failure at a single institute between September 2018 and February 2020 were prospectively reviewed. The double-blinded collected data were presented to three board-certificate attending surgeons. Surgeons were asked to decide whether to perform one-stage or two-stage revision ACLR based on the evaluation of the CT scan images and the 3D-printed custom-made models at two different rounds, T0 and T1, respectively, 7 days apart one from the other. Interoperator consensus following technical mistake was 52% at T0 and 56% at T1 using the CT scans, meanwhile concordance was 95% at T0 and 94% at T1 using the 3D models. Concordance between surgeons following new knee injury was 66% at T0 and 70% at T1 using CT scans, while concordance was 96% both at T0 and T1 using 3D models. Intraoperative variability using 3D models was extremely low: concordance at T0 and T1 was 98%. McNemar test showed a statistical significance in the use of 3D model for preoperative planning (p < 0.005). 3D-printed model reliability resulted to be higher compared with CT as intraoperator surgery technique selection was not modified throughout time from T0 to T1 (p < 0.005). The use of 3D-printed models had the most impact when evaluating femoral and tibial tunnels, resulting to be a useful instrument during preoperative planning of revision ACLR between attending surgeons with medium-high workflow.

Keywords

revision ACL reconstruction - preoperative planning - 3D-printed model - decision-making process

Ethical Statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.




Publication History

Received: 13 July 2023

Accepted: 23 April 2024

Accepted Manuscript online:
27 April 2024

Article published online:
24 May 2024

© 2024. Thieme. All rights reserved.

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