Arthroscopic Visualization Is a Reliable Method of Confirming Femoral Button Placement During Anterior Cruciate Ligament Reconstruction

PURPOSE: To compare arthroscopic visualization with intraoperative fluoroscopy for confirming proper femoral button placement during ACLR. METHODS: Fifty consecutive patients undergoing soft-tissue ACLR between March 2021 and February 2022 were evaluated for inclusion in this study. Both primary and revision ACLR cases using suspensory fixation were included. Surgeons rated their confidence of proper button placement from both an intra-articular perspective (through the femoral tunnel) and an extra-articular perspective (through the iliotibial band) by grading confidence with a Likert scale. Fluoroscopy was also performed for confirmation of proper button placement. RESULTS: Fifty consecutive patients (35.1 ± 14.5 years of age) with soft-tissue ACLR were included. Mean surgeon Likert confidence scores for accurate button placement were as follows: 4.1 of 5 ± 0.9 from an intra-articular perspective, 4.6 of 5 ± 0.7 from an extra-articular perspective, and 8.7 of 10 ± 1.4 based on the sum of intra- and extra-articular perspectives. Fluoroscopic findings demonstrated that 48 of 50 cases had an appropriate flipped button on the lateral cortex of the femur. I total, 2 of 50 had soft-tissue interposition. Cases in which surgeons had high confidence from both intra- and extra-articular perspectives (≥9/10 sum score) were indicative of proper button placement 97% of the time. CONCLUSIONS: Arthroscopic visualization is a reliable method of confirming femoral button placement during ACLR and is sufficient to rule out intraoperative fluoroscopy during surgery. ACLR cases with high surgeon confidence from both intra- and extra-articular perspectives (sum score of 9 or greater out of 10) resulted in proper femoral button placement in 97% of cases as confirmed by intraoperative fluoroscopy. LEVEL OF EVIDENCE: Level II, prospective cohort study.