Improving Femoral Tunnel Placement in Canine Cranial Cruciate Ligament Reconstruction Using a Novel Adjustable Aiming Device: Evaluation Through Simulated Surgical Trials

Accurate femoral tunnel placement in canine cranial cruciate ligament (CrCL) reconstruction is challenging because of small joint anatomy and limited dedicated instrumentation. This study evaluated an adjustable femoral tunnel aiming device combined with patient-specific preoperative planning. Thirteen surgeons (six experienced and seven novices) performed simulated tunnel positioning using the device and a freehand technique. Outcomes included aperture positional error, measured as Euclidean distance (ED), angular deviation (AD), positioning time, and intra- and intersurgeon variability. Device-guided positioning reduced EDs (4.1–4.7 mm vs. 5.1–6.2 mm; p = 0.0275) and ADs (6.4–8.2° vs. 10.7–12.6°; p = 0.0038). Neither surgeon experience nor its interaction with technique significantly affected EDs or ADs. The device significantly reduced intrasurgeon variability in both outcomes and intersurgeon ADs variability among experienced surgeons. However, systematic distal bias (3.1–3.4 mm; p < 0.001) was observed with device-guided positioning. These findings support improved positioning accuracy and consistency with the device in simulated canine CrCL reconstruction. Further device refinement and hands-on practice may help address systematic deviations, while additional cadaveric and clinical validation is required before clinical application.