Evaluate precisely and reproducibly tridimensional positioning of bone tunnels in anterior cruciate ligament reconstructions (ACL). To propose biplanar stereoradiographic imaging as a new reference in tridimensional evaluation of ACL reconstruction (ACLR). Comparing knee 3D models issued from EOStm low-irradiation biplanar X-Ray with those issued from computed tomography (CT-Scan) high definition images will allow a bone morphological description of a previously unseen precision. We carried out the transfer of 3D models from EOStm X-Ray images obtained from 10 patients in the same reference frame with models issued from CT-Scan. Two evaluators reconstructed both pre-operative and post-operative knees, using two different stereoradiographic projections, for a total of 144 knee 3D models from EOStm. A surface analysis by distance mapping allowed us to know the differences or errors between the homologous points of the EOStm and CT reconstructions, the latter being our “bronze-standard”. At the femur, we obtained a mean (95% confidence level) error of 1.5 mm (1.3–1.6) between the EOStm models compared to the Arthro-CT segmentations when using AP-LAT incidences, compared to 1 mm (1.0 – 1.1) with oblique projections. For the tunnels placement analysis, the total radius difference between EOStm and Arthro-CT's femoral tunnel apertures was 0.8 mm (0.4–1.2) in AP-LAT and 0.6 mm (0.0–1.2) in oblique views. These femoral apertures positioning on EOStm models were within 4.3 mm (3.0–5.7) of their homologues on CT-Scan models, 4.6 mm (3.5–5.6) with the oblique views. Furthermore, 9.3o (7.2–11.4) of difference in direction between femoral tunnels from EOStm models and CT reconstructions is obtained with AP-LAT projections, 8.3o (6.6–10) with obliques views. Measures of these parameters were also performed at the tibia. According to the intra and inter-reproducibility analysis of our knee 3D models, EOStm biplanar X-Ray images prove to be fast, efficient and precise in the design of ACLR 3D models with respect to CT-Scan. Our results also propose the recourse of oblique stereoradiographic projections for the realization of knee 3D models. These models will be subjects of further analysis and will allow us eventually to propose a new frame of reference guiding the positioning of the tunnels in the ACLR.
