RESEARCH ARTICLE


3D-Printed Patient-Specific ACL Femoral Tunnel Guide from MRI



Iain Rankin1, *, Haroon Rehman1, Mark Frame2
1 Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern Ireland
2 University Hospital Southampton NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedic Surgery Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland


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Creative Commons License
© 2018 Rankin et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Aberdeen Royal Infirmary - Trauma and Orthopaedic Surgery, Foresterhill Aberdeen AB25 2ZN, United Kingdom of Great Britain and Northern, Ireland; Tel: 03454566000; E-mail: iain.rankin@doctors.org.uk


Abstract

Background:

Traditional ACL reconstruction with non-anatomic techniques can demonstrate unsatisfactory long-term outcomes with regards instability and the degenerative knee changes observed with these results. Anatomic ACL reconstruction attempts to closely reproduce the patient's individual anatomic characteristics with the aim of restoring knee kinematics, in order to improve patient short and long-term outcomes. We designed an arthroscopic, patient-specific, ACL femoral tunnel guide to aid anatomical placement of the ACL graft within the femoral tunnel.

Methods:

The guide design was based on MRI scan of the subject's uninjured contralateral knee, identifying the femoral footprint and its anatomical position relative to the borders of the femoral articular cartilage. Image processing software was used to create a 3D computer aided design which was subsequently exported to a 3D-printing service.

Results:

Transparent acrylic based photopolymer, PA220 plastic and 316L stainless steel patient-specific ACL femoral tunnel guides were created; the models produced were accurate with no statistical difference in size and positioning of the center of the ACL femoral footprint guide to MRI (p=0.344, p=0.189, p=0.233 respectively). The guides aim to provide accurate marking of the starting point of the femoral tunnel in arthroscopic ACL reconstruction.

Conclusion:

This study serves as a proof of concept for the accurate creation of 3D-printed patient-specific guides for the anatomical placement of the femoral tunnel during ACL reconstruction.

Keywords: Anterior Cruciate Ligament, ACL, Anatomic, Anterior Cruciate Ligament reconstruction, Printing, Three-dimensional, Arthroscopy.