Archives of orthopaedic and trauma surgery
October 13, 2026 · via Europe PMC
Notch-referenced mediolateral verification of tibial tunnel position in anterior cruciate ligament reconstruction: a 3D imaging validation study.
Nam VT, Thang VD, Huy LD, +8 more, Dung TT.
AI summary — for doctors, generated from the abstract only
An equipment-free notch-referenced technique placed the tibial tunnel within about 1 mm of the native mediolateral footprint center in ACL reconstruction.
What was studied
A retrospective cross-sectional study of 108 consecutive patients having all-inside single-bundle ACL reconstruction with intraoperative verification, comparing postoperative 3D CT tunnel position with preoperative 3D MRI footprint center.
Key findings
- The native footprint center was at 46.1 ± 2.3% of plateau width versus 44.8 ± 2.0% for the tunnel center
- Mean mediolateral deviation was -1.01 ± 1.52 mm
- Measurement reliability was reported as high
Clinical relevance
A simple intraoperative aid for a common cause of ACL reconstruction failure, requiring no special equipment.
Who should care
Limitations
Single-arm study without a comparison group (Level IV), no clinical outcomes, and the p-value and reliability statistics are cut off in the abstract text.
Tunnel position was accurate, but benefit for patient outcomes is unproven.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Non-anatomic tibial tunnel placement remains a leading contributor to anterior cruciate ligament reconstruction (ACLR) failure. Mediolateral (ML) tunnel positioning is particularly difficult intraoperatively because no consistent bony landmark defines the lateral footprint border.
Purpose
To evaluate the accuracy of a novel intraoperative Notch-Referenced Mediolateral (NRML) verification technique by comparing the ML position of the tibial tunnel center (TTC) on postoperative 3D CT with the native tibial footprint center (TFC) on preoperative 3D MRI.
Methods
In this retrospective cross-sectional study, 108 consecutive patients underwent primary all-inside single-bundle ACLR with intraoperative NRML verification. This arthroscopic technique uses the intercondylar notch as a visual reference to verify mediolateral tibial tunnel position before definitive drilling. TFC and TTC were independently measured on preoperative 3D MRI and postoperative 3D CT using a standardized quadrant-grid protocol by two blinded observers. The primary outcome was ML deviation (tunnel - footprint). MRI-CT agreement and measurement reliability were assessed with intraclass correlation coefficients (ICC) and Bland-Altman analysis.
Results
The anatomical TFC was located at 46.1 ± 2.3% of tibial plateau width in the ML direction, versus 44.8 ± 2.0% for the TTC. Mean ML deviation was -1.01 ± 1.52 mm (p < 0.001), a small but statistically significant medial bias; 91.7% (95% CI 84.9-95.6%) of tunnels fell within ±3 mm of the native footprint. MRI-CT agreement was good (ICC 0.81-0.85), and inter/intraobserver reliability was good to excellent (ICC 0.78-0.89). No significant associations were found between ML deviation and sex, injury chronicity, graft diameter, or plateau size.
Conclusion
In this single-arm cohort,NRML verification is a simple, equipment-free technique that placed the tibial tunnel within ~1 mm of the native ML footprint, with high measurement reliability. Prospective comparative and outcome studies are needed to confirm its clinical value.
Level of evidence
IV.
DOI
10.1007/s00402-026-06442-w
PMID
42867698
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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