The Use of Customized 3D-Printed Guides in Anterior Cruciate Ligament Reconstruction Compared With Conventional Techniques: A Systematic Review and Meta-analysis

Background: Accurate femoral tunnel positioning is essential for successful anterior cruciate ligament (ACL) reconstruction. Tunnel malposition can happen due to limited arthroscopic visibility as well as anatomic variance. The use of customized patient-specific guides can optimize surgical planning and enhance accuracy. Purpose: To compare femoral tunnel positioning in 3-dimensional (3D)-assisted ACL reconstruction versus conventional surgery. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: This systematic review and meta-analysis was performed in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. All randomized controlled trials (RCTs) and observational studies comparing the 2 interventions were included. Primary outcomes included tunnel positioning time (minutes) and accuracy rates (%). Secondary outcomes were Lysholm and International Knee Documentation Committee (IKDC) functional scores. Random effects modeling was used for analysis. Results: Four RCTs and 1 retrospective study were included, enrolling a total of 299 patients. The 3D group had significantly shorter tunnel positioning times (mean difference, –2.80; 95% CI, –4.13 to −1.46; P < .0001) with significantly greater tunnel positioning accuracy (odds ratio, 4.62; 95% CI, 1.02 to 20.89; P = .05). No significant difference was noted in postoperative functional scores, including Lysholm and IKDC scores ( P > .05). Conclusion: The use of 3D guides helps reduce tunnel positioning time and increases tunnel positioning accuracy with comparable postoperative functional outcomes.