App-Based Analysis of Fluoroscopic Images According to Bernard-Hertel Method for the Determination of Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction.

The accurate positioning of the femoral tunnel is crucial for the success of anterior cruciate ligament reconstruction. Malpositioning of the tunnel is believed to be one of the most important reasons for graft failure. While use of anatomic landmarks and industry-supplied aiming devices aid the surgeon in placing the drill pin in the correct position, fluoroscopic imaging is an additional tool used intraoperatively to verify pin placement. While interpretation of fluoroscopic imaging is frequently based on eyeball measurement, a more accurate analysis of a lateral image uses the quadrant method by Bernard-Hertel. This method has been primarily used for scientific research due to its complexity and has not been integrated into clinical routine yet. We present a digital app-based approach to easily quantify the femoral pin position based on the quadrant method. This approach is mobile and easy to use. Quantification of pin position of femoral bone tunnel on a lateral fluoroscopic image may be used for quality control and teaching purposes or may provide the surgeon with additional information during ACL reconstruction.

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© 2023 The Authors.

Déclaration de conflit d'intérêts

The authors report the following potential conflicts of interest or sources of funding: J.H. is the originator and copyright holder of the ACL-X app, receives financial benefits from user fees for using the ACL-X app in the Apple store, and is a paid consultant for Richard Wolf Corp. Knittlingen, Germany, and OPED Corp., Valley, Germany. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.