Notch-referenced mediolateral verification of tibial tunnel position in anterior cruciate ligament reconstruction: a 3D imaging validation study

IF 2.2 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2026-10-13 DOI:10.1007/s00402-026-06442-w

Vu Tu Nam, Vu Duc Thang, Le Duc Huy, Luu Huu Phuc, Luong Nhat Anh, Le Duc Thinh, Chu Hoang Long, Nguyen Ngoc Huyen, Nguyen Duc Trung, Ta Van Thanh Nam, Ho Ngoc Minh, Tran Trung Dung

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引用次数: 0

Abstract

Background

Non-anatomic tibial tunnel placement remains a leading contributor to anterior cruciate ligament reconstruction (ACLR) failure. Mediolateral (ML) tunnel positioning is particularly difficult intraoperatively because no consistent bony landmark defines the lateral footprint border.

Purpose

To evaluate the accuracy of a novel intraoperative Notch-Referenced Mediolateral (NRML) verification technique by comparing the ML position of the tibial tunnel center (TTC) on postoperative 3D CT with the native tibial footprint center (TFC) on preoperative 3D MRI.

Methods

In this retrospective cross-sectional study, 108 consecutive patients underwent primary all-inside single-bundle ACLR with intraoperative NRML verification. This arthroscopic technique uses the intercondylar notch as a visual reference to verify mediolateral tibial tunnel position before definitive drilling.

TFC and TTC were independently measured on preoperative 3D MRI and postoperative 3D CT using a standardized quadrant-grid protocol by two blinded observers. The primary outcome was ML deviation (tunnel - footprint). MRI–CT agreement and measurement reliability were assessed with intraclass correlation coefficients (ICC) and Bland–Altman analysis.

Results

The anatomical TFC was located at 46.1 ± 2.3% of tibial plateau width in the ML direction, versus 44.8 ± 2.0% for the TTC. Mean ML deviation was −1.01 ± 1.52 mm (p < 0.001), a small but statistically significant medial bias; 91.7% (95% CI 84.9–95.6%) of tunnels fell within ±3 mm of the native footprint. MRI–CT agreement was good (ICC 0.81–0.85), and inter/intraobserver reliability was good to excellent (ICC 0.78–0.89). No significant associations were found between ML deviation and sex, injury chronicity, graft diameter, or plateau size.

Conclusion

In this single-arm cohort,NRML verification is a simple, equipment-free technique that placed the tibial tunnel within ~1 mm of the native ML footprint, with high measurement reliability. Prospective comparative and outcome studies are needed to confirm its clinical value.

Level of evidence

IV.

查看原文本刊更多论文

前交叉韧带重建中参考缺口胫骨隧道位置的中外侧验证：一项三维成像验证研究。

背景：非解剖性胫骨隧道放置仍然是导致前交叉韧带重建（ACLR）失败的主要原因。术中中外侧（ML）隧道定位特别困难，因为没有一致的骨标记定义外侧足迹边界。目的：通过比较术后3D CT上胫骨隧道中心（TTC）的ML位置与术前3D MRI上胫骨足印中心（TFC）的ML位置，评价一种新型术中切口参考内外侧（NRML）验证技术的准确性。方法：在这项回顾性横断面研究中，108例连续患者接受了原发性全内单束ACLR并术中NRML验证。这种关节镜技术使用髁间切迹作为视觉参考，在确定钻孔之前验证胫骨内外侧隧道的位置。TFC和TTC分别由两名盲法观察者在术前3D MRI和术后3D CT上采用标准化象限网格方案独立测量。主要结果是ML偏差（隧道足迹）。采用类内相关系数（ICC）和Bland-Altman分析评估MRI-CT一致性和测量可靠性。结果：解剖上TFC位于胫骨平台宽度的46.1±2.3%，而TTC位于胫骨平台宽度的44.8±2.0%。平均ML偏差为-1.01±1.52 mm (p < 0.001)，中间偏倚较小，但有统计学意义；91.7% （95% CI 84.9 ~ 95.6%）的隧道落在原生足迹的±3mm范围内。MRI-CT一致性良好（ICC 0.81-0.85），观察者间/观察者内信度良好至优秀（ICC 0.78-0.89）。ML偏差与性别、损伤慢性、移植物直径或平台大小之间没有明显关联。结论：在这个单臂队列中，NRML验证是一种简单的，无设备的技术，将胫骨隧道放置在原生ML足迹的约1mm内，测量可靠性高。需要前瞻性比较和结局研究来证实其临床价值。证据等级：四级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).