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Outcomes After Conventional Versus Computer-Navigated Anterior Cruciate Ligament Reconstruction

Published:February 13, 2008DOI:https://doi.org/10.1016/j.arthro.2007.12.007
      Purpose: The purpose of this prospective randomized study was to assess biomechanical, radiographic, and functional results after single-bundle anterior cruciate ligament (ACL) reconstruction by use of a navigation system. Methods: ACL reconstruction was performed by use of the OrthoPilot navigation system (B. Braun-Aesculap, Tuttlingen, Germany) in 40 patients (group 1); and in another 40 patients, surgery was done by the standard manual targeting technique (group 2). The anterior laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Femoral and tibial tunnel position was evaluated radiologically according to the method described by Bernard and Hertel and by Harner et al., respectively. The questionnaire-based Lysholm and International Knee Documentation Committee scales were included to compare the functional state in both groups. Results: The knees in group 1 were as stable as those in group 2 during the arthrometer testing, with a lower value of dispersion. The postoperative Lysholm and International Knee Documentation Committee scores had the same value in both groups. Statistical differences existed with regard to anterior-posterior femoral tunnel placement when the navigated and standard techniques were compared; in the navigated group, more exact results were found. No significant complications were observed. Conclusions: The only difference that we found between the navigated and standard groups was in radiographic tunnel position measurement. The computer-assisted navigation technique in our study resulted in more accurate tunnel placement in the femur (but not the tibia) than the traditional arthroscopic technique. However, the performed standard radiographic measurements are of limited precision in principle. Functional scales and stability tests gave similar results in both groups. Level of Evidence: Level I, therapeutic study.

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      References

        • Koh J.L.
        Navigation and ACL reconstruction.
        in: Presented at the 25th Annual Meeting of the Arthroscopy Association of North America, Hollywood, FL, May2006
        • Irvine G.B.
        • Glasgow M.M.S.
        The natural history of the meniscus in anterior cruciate insufficiency: Arthroscopic analysis.
        J Bone Joint Surg Br. 1992; 74: 403-405
        • Višňa P.
        • Adler J.
        • Folvarský J.
        • Paša L.
        • Horký D.
        Treatment of deep chondral defects of the knee using autologous chondrocytes cultured on a support-Preparation of the cartilage graft.
        Acta Chir Orthop Traumatol Cech. 2003; 70 (in Czech): 350-355
        • Maffulli N.
        • Binfield P.M.
        • King J.B.
        Articular cartilage lesions in the symptomatic anterior cruciate ligament–deficient knee.
        Arthroscopy. 2003; 19: 685-690
        • Hart A.J.
        • Buscombe J.
        • Malone A.
        • Dowd G.S.E.
        Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament.
        J Bone Joint Surg Br. 2005; 87: 1483-1487
        • Jimha N.M.
        • Borton D.C.
        • Clingeleffer A.J.
        • Pinczewski L.A.
        Long term osteoarthritic changes in anterior cruciate ligament reconstructed knees.
        Clin Orthop Relat Res. 1999; : 188-193
        • Barrett G.R.
        • Treacy S.H.
        The effect of intraoperative isometric measurement on the outcome of anterior cruciate ligament reconstruction: A clinical analysis.
        Arthroscopy. 1996; 12: 645-651
        • Kohn D.
        • Beusche T.
        • Caris J.
        Drill hole position in endoscopic anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: 13-15
        • Sudhahar T.A.
        • Glasgow M.M.
        • Donell S.T.
        Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction.
        Knee. 2004; 11: 15-18
        • Sati M.
        • Staubli H.U.
        • Bourquin Y.
        • Kunz M.
        • Nolte L.P.
        Real-time computerized in situ guidance system for ACL graft placement.
        Comput Aided Surg. 2002; 7: 25-40
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of the knee ligament injuries.
        Clin Orthop Relat Res. 1985; 198: 43-49
        • Harner C.D.
        • Marks P.H.
        • Fu F.H.
        • Irrgang J.J.
        • Silby M.B.
        • Mengato R.
        Anterior cruciate ligament reconstruction: Endoscopic versus two-incision technique.
        Arthroscopy. 1994; 10: 502-512
        • Bernard M.
        • Hertel P.
        Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty.
        Unfallchirurg. 1996; 99 (in German): 332-340
        • Bernard M.
        • Hertel P.
        • Lais E.
        • Gomez F.
        Reconstruction of the proximal insertion of the anterior cruciate ligament.
        Unfallchirurg. 1990; 93 (in German): 565-569
        • Musahl V.
        • Burkart A.
        • Debski R.E.
        • Van Scyoc A.
        • Fu F.H.
        • Woo S.L.
        Anterior cruciate ligament tunnel placement: Comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system.
        Arthroscopy. 2003; 19: 154-160
        • Schep N.W.L.
        • Stavenuiter M.H.J.
        • Diekerhof C.H.
        • et al.
        Intersurgeon variance in computer-assisted planning of anterior cruciate ligament reconstruction.
        Arthroscopy. 2005; 21: 942-947
        • Klos T.V.S.
        • Habets R.J.E.
        • Banks A.Z.
        • Banks S.A.
        • Devilee R.J.J.
        • Cook F.F.
        Computer assistance in arthroscopic anterior cruciate ligament reconstruction.
        in: DiGioia A.M. Jaramaz B. Picard F. Nolte L.P. Computer and robotic assisted knee and hip surgery. Oxford University Press, Oxford2004: 229-234
        • Sati M.
        • Staubli H.U.
        • Bourquin Y.
        • Kunz M.
        • Kasermann S.
        • Nolte L.P.
        Clinical integration of computer-assisted technology for arthroscopic anterior cruciate ligament reconstruction.
        Oper Tech Orthop. 2000; 10: 40-49
        • Dessenne V.
        • Lavallee S.
        • Julliard R.
        • Orti R.
        • Martelli S.
        • Cinquin P.
        Computer-assisted knee anterior cruciate ligament reconstruction: First clinical tests.
        J Image Guid Surg. 1995; 1: 59-64
        • Picard F.
        • DiGioia A.M.
        • Moody J.
        • et al.
        Accuracy in tunnel placement for ACL reconstruction.
        Comput Aided Surg. 2001; 6: 279-289
        • Koh J.L.
        Computer assisted surgery for sports medicine: ACL, HTO, cartilage.
        in: Presented at the 25th Annual Meeting of the Arthroscopy Association of North America, Hollywood, FL, May2006
        • Bernsmann K.
        • Rosenthal A.
        • Sati M.
        • Ansari B.
        • Wiese M.
        Using the CAS (computer-assisted surgery) system in arthroscopic cruciate ligament surgery—Adaptation and application in clinical practice.
        Z Orthop Ihre Grenzgeb. 2001; 139 (in German): 346-351
        • Müller-Alsbach U.W.
        • Staubli A.E.
        Computer aided ACL reconstruction.
        Injury. 2004; 35: 65-67
        • Colombet P.
        • Robinson J.
        • Christel P.
        • Franceschi J.P.
        • Djian P.
        Using navigation to measure rotation kinematics during ACL reconstruction.
        Clin Orthop Relat Res. 2007; 454: 59-65
        • Hiraoka H.
        • Kuribayashi S.
        • Fukuda A.
        • Fukui N.
        • Nakamura K.
        Endoscopic anterior cruciate ligament reconstruction using a computer-assisted fluoroscopic navigation system.
        J Orthop Sci. 2006; 11: 159-166
        • Degenhart M.
        Computer-navigated ACL reconstruction with the OrthoPilot.
        Surg Technol Int. 2004; 12: 245-251
        • Ishibashi Y.
        • Tsuda E.
        • Tazawa K.
        • Sato H.
        • Toh S.
        Intraoperative evaluation of the anatomical double-bundle anterior cruciate reconstruction with the OrthoPilot navigation system.
        Orthopedics. 2005; 28: s1277-s1282
        • Koh J.L.
        Computer-assisted navigation and anterior cruciate ligament reconstruction; accuracy and outcomes.
        Orthopedics. 2005; 28: s1283-s1287
        • Georgoulis A.D.
        • Ristanis S.
        • Chouliaras V.
        • Moraiti C.
        • Stergio N.
        Tibial rotation is not restored after ACL reconstruction with a hamstring graft.
        Clin Orthop Relat Res. 2007; 454: 89-94
        • Bendit D.L.
        • Ramsey D.K.
        • Lamontagne M.
        • Xu L.
        • Wretenberg P.
        • Renström P.
        In vivo knee kinematics during gait reveals new rotation profiles and smaller translations.
        Clin Orthop Relat Res. 2007; 454: 81-88
        • Zaffagnini S.
        • Bignozzi S.
        • Martelli S.
        • Lopomo N.
        • Marcacci M.
        Does ACL reconstruction restore knee stability in combined lesions?.
        Clin Orthop Relat Res. 2007; 454: 95-99
        • Boden B.
        • Migaud H.
        • Gougeon F.
        • Debroucker M.J.
        • Duquennoy A.
        Effect of graft position on laxity after anterior cruciate ligament reconstruction.
        Acta Orthop Belg. 1996; 62: 2-7
        • Khalfayan E.E.
        • Sharkey P.F.
        • Alexander A.H.
        • Bruckner J.D.
        The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction.
        Am J Sports Med. 1996; 24: 335-341