Accuracy of Anterior Cruciate Ligament Footprint Localization: Intraoperative versus Preoperative Magnetic Resonance Imaging Assessment

Background: Accurate localization of the anterior cruciate ligament (ACL) footprint is essential for successful reconstruction. Conventional intraoperative techniques may lack precision. Aims and Objectives: To compare the accuracy of intraoperative methods with preoperative MRI-based techniques for ACL footprint localization. Materials and Methods: A comprehensive literature review (2023–2025) was conducted using PubMed and Google Scholar. Studies comparing MRI-based and intraoperative techniques were analyzed for accuracy and clinical outcomes. Results: 3D MRI demonstrated high accuracy with deviations of ~1–2 mm. Both 2D and 3D MRI showed excellent reliability (<1.2 mm difference). In contrast, intraoperative methods showed greater variability (~4–5 mm). Navigation and patient-specific guides improved accuracy but still demonstrated minor deviations (~5 mm). Conclusion: MRI-based planning, especially 3D MRI combined with navigation or patient-specific guides, provides superior accuracy in ACL footprint localization and may reduce graft failure rates.