Arthroscopic visualization reliable method of confirming Femoral Button placement during ACL reconstruction

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-06-07T20:00:41+05:30 | Updated On 7 Jun 2023 8:01 PM IST

M. J. TALAMO et al conducted a study to compare arthroscopic visualization with intraoperative fluoroscopy for confirming proper femoral button placement during ACLR. It was conducted at “ONS Foundation for Clinical Research and Education, Greenwich, Connecticut, U.S.A.”

Fifty consecutive patients undergoing soft-tissue ACLR were evaluated for inclusion in this study. Both primary and revision ACLR cases using suspensory fixation were included. Surgeons rated their confidence of proper button placement from both an intra-articular perspective (through the femoral tunnel) and an extra-articular perspective (through the iliotibial band) by grading confidence with a Likert scale. Fluoroscopy was also performed for confirmation of proper button placement.

Key findings of the study were:

• Fifty consecutive patients (35.1 +/- 14.5 years of age) with soft-tissue ACLR were included.

• Mean surgeon Likert confidence scores for accurate button placement were as follows: 4.1 of 5 +/- 0.9 from an intra-articular perspective, 4.6 of 5 +/- 0.7 from an extra articular perspective, and 8.7 of 10 +/- 1.4 based on the sum of intra- and extra-articular perspectives.

• Fluoroscopic findings demonstrated that 48 of 50 cases had an appropriate flipped button on the lateral cortex of the femur. I total, 2 of 50 had soft-tissue interposition.

• Cases in which surgeons had high confidence from both intra- and extra-articular perspectives (>=9/10 sum score) were indicative of proper button placement 97% of the time.

The authors concluded that – “Arthroscopic visualization is a reliable method of confirming femoral button placement during ACLR and is sufficient to rule out intraoperative fluoroscopy during surgery. ACLR cases with high surgeon confidence from both intra- and extra-articular perspectives (sum score of 9 or greater out of 10) resulted in proper femoral button placement in 97% of cases as confirmed by intraoperative fluoroscopy.”

Level of Evidence: Level II, prospective cohort study.

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751