Title : 3D CT analysis and software-assisted pre-operative planning of tunnel position in revision ACL reconstruction
Abstract:
Background: Re-rupture of Anterior Cruciate Ligament (ACL) following Reconstruction (ACLR) remains prevalent, with failure following revision reconstruction making the scenario further challenging to manage. Optimising pre-operative planning may therefore play an important role in supporting surgical decision-making and improving outcomes following revision ACLR.
Aims: This paper aims to evaluate the use of pre-operative planning, such as CT-based software reports, to develop patient-specific surgery plans and potential to design custom implants for patients who undergo revision ACLR.
Methods: The pre-operative CT scans and long-leg alignment radiographs of 12 patients, who have undergone revision ACLR, were analysed using software that generated 3-dimensional anatomical models and quantitative reports (Personalised SurgeryTM, Sydney, Australia). These reports incorporated anatomical alignment, bone stock, and femoral and tibial morphology to provide data and recommendations regarding tunnel position, morphology and dimensions. The resulting reports were subsequently used to develop a questionnaire assessing their usefulness in pre-operative planning of revision ACLR. The questionnaire was distributed to knee surgeons at Addenbrooke’s Hospital.
Results: The 3-dimensional reports clearly visualised existing and proposed tunnel positions using colour coding, while providing detailed measurements of tunnel dimensions. All the five surgeons surveyed reported that they would use the reports to aid and independently verify their pre-operative planning, with all participants stating that the analysis of femoral and tibial tunnel position and trajectory was valuable. 100% also felt the reports would assist in determining whether a single- or two-stage revision was appropriate, and all surgeons considered the reports useful, clear and easy to interpret. Furthermore, all participants believed that improved pre-operative planning could influence surgical success and that they would use the software in future revision ACLR planning. 80% viewed the technology as a step towards patient-specific surgical planning, while 60% felt it could assist with implant and instrument selection.
Conclusion: Overall, these findings suggest that software-assisted 3D CT analysis has considerable potential to enhance decision-making and optimise pre-operative planning in revision ACLR. The strong preference among surgeons for incorporating these reports into their pre-operative planning highlights their perceived clinical value. These CT-based analyses have the potential to reinforce surgeons’ chosen surgical strategies, while providing additional patient-specific information to support decision-making, particularly in complex revision cases. This technology represents an exciting step towards more personalised surgical planning and, ultimately, the potential to develop custom implants, with the potential to improve surgical outcomes.
