Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure, reporting poorer outcomes compared to the primary procedure. Identification of the cause of primary failure and a thorough pre-operative evaluation is required to plan the most appropriate surgical approach. 3D printing technology has become increasingly commonplace in the surgical setting. In particular, patient-specific anatomical models can be used to aid pre-operative planning of complicated procedures. We have conducted a qualitative study to gauge the interest amongst orthopaedic knee surgeons in using a 3D-printed model to plan revision ACL reconstructions.

A tibia and femur model was printed from one patient who is a candidate for the procedure. The binder jetting printing technique was performed, using Visijet PXL Core powder. 12 orthopaedic knee surgeons assessed the usefulness of the 3D-printed model compared to conventional CT images on a likert scale. 6 key steps of preoperative planning were assessed, including the size and location of the tunnel defects, the need for notchplasty, and whether a staged revision was required.

We found that surgeons preferred the 3D-printed model to conventional CT images only, and 83% of them would use such a model for both pre-operative simulation, and as an intra-operative reference. However, there were some variation in the perceived usefulness of the model in several areas assessed. This may reflect differences in individual approach towards planning of the procedure.

Our findings suggest that 3D-printed models could be a versatile pre-operative and intra-operative tool for complicated arthroscopic knee surgery. While 3D printing technology is becoming increasingly accessible and affordable, in-depth cost-effectiveness studies need to be conducted before it can be integrated into clinical. Further study would be needed to determine the clinical utility and economic cost-effectiveness of the 3D-printed model in revision ACL reconstruction.