Fluoroscopic-Based Navigation-Assisted Placement of the Tibial Tunnel in Revision Anterior Cruciate Ligament Reconstruction

With the increasing number of primary anterior cruciate ligament (ACL) reconstructions, revisions are more frequent. The most common cause of technical failure in primary ACL reconstruction is the bone tunnel misplacement. An incorrectly positioned bone tunnel or tunnel enlargement interferes with correct tunnel placement, which is critical for successful restoration of the knee kinematics. We describe a technique using fluoroscopic-based navigation systems to place the tibial tunnel in an ideal position with accuracy and reproducibility in the revision ACL reconstruction. With a reference frame attached to the middle part of the tibia, the conventional tibial guide with a tracking device provides surgeons with real-time visual guidance in multiple image planes. In 3 revision cases with incorrect tibial tunnels and without bone enlargement, the new tibial tunnel could be created in the ideal position under the control of the navigation system. Computer navigation and virtual ligament reconstruction enable surgeons to control bone tunnel positioning during technically demanding revision ACL cases.