Trial reportKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
Flexible reamers create comparable anterior cruciate ligament reconstruction femoral tunnels without the hyperflexion required with rigid reamers: 3D-CT analysis of tunnel morphology in a randomised clinical trial.
Trial report in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 15 citations in OpenAlex.
- Comparisons of the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in arthroscopic anterior cruciate ligament reconstruction.Joint diseases and related surgery · 2026Article
- Popliteal Artery Stent Thrombosis After Multiligamentous Knee Injury Reconstruction: A Case Report.JBJS case connector · 2024Article
- Comparison of femoral tunnel position and knee function in anterior cruciate ligament reconstruction: a retrospective cohort study using measuring-fluoroscopy method versus bony marker method.BMC musculoskeletal disorders · 2024Article
- Article
- Distribution of bone tunnel positions and treatment efficacy of bone landmark positioning method for anatomical reconstruction of the anterior cruciate ligament: a case control study.BMC musculoskeletal disorders · 2023Article
- Femoral Tunnel Geometry and Graft Inclination Angles in Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System.Medicina (Kaunas, Lithuania) · 2023Article
- Investigation of the Importance of Knee Position during Femoral Tunnel Reaming; Figure 4 versus Hyperflexion.Malaysian orthopaedic journal · 2022Article
- Flexible Versus Rigid Reaming Systems for Independent Femoral Tunnel Reaming During ACL Reconstruction: Minimum 2-Year Clinical Outcomes.Orthopaedic journal of sports medicine · 2022Article
- Clinical outcome and computer tomography based tunnel placement evaluation following arthroscopic anteromedial portal anterior cruciate ligament reconstruction in non-athletic population.International journal of burns and trauma · 2022Article
- Comparing the Use of Flexible and Rigid Reaming Systems Through an Anteromedial Portal for Femoral Tunnel Creation During Anterior Cruciate Ligament Reconstruction: A Systematic Review.Orthopaedic journal of sports medicine · 2021Review
- A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study.Knee surgery & related research · 2020Article
- A two-portal technique using a flexible reamer system is a safe and effective method for transportal anterior cruciate ligament reconstruction.Archives of orthopaedic and trauma surgery · 2020Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe hyperflexion required for femoral tunnel drilling in anterior cruciate ligament reconstruction can be challenging in patients with increased body habitus or musculature. Whilst allowing femoral tunnel creation without hyperflexion, additional benefits of flexible reamers have been proposed in terms of tunnel dimensions. The purpose of this study was to examine whether these theoretical benefits are seen in a clinical study.
methodsFifty adult patients (with isolated anterior cruciate ligament rupture) were randomised to reconstruction with either flexible or rigid femoral reamers. Femoral tunnel drilling was performed at 100° flexion (flexible system) or maximal hyperflexion (rigid system). Otherwise, the procedure was standardised. Femoral tunnel measurements were performed by a consultant musculoskeletal radiologist who was blinded to the method of femoral drilling. Tunnel position, length and angles (axial and coronal) were measured alongside aperture shape and exit point using three-dimensional computed tomography 3-6 months post-operatively.
resultsWith no difference in tunnel position, tunnel length was found to increase with the use of the flexible system (37.8 ± 3.7 vs 35.0 ± 4.4 mm; p = 0.024). In addition, the exit point and fixation device were more anterior on the lateral femur using the flexible reamers (p = 0.016). No difference was seen in either tunnel angles or aperture shape. One case of incomplete posterior blow-out was seen in each of the study groups.
conclusionsThis comparative study shows that flexible reamers can reproduce a desired femoral tunnel position with only small improvements of no clinical relevance. As this can be achieved without hyperflexing the knee, these systems can be used for all patients (even when hyperflexion is a challenge). LEVEL OF EVIDENCE: I.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.