Purpose
The purpose of this study was to evaluate the benefits of computer navigation on tunnel
placement during anterior cruciate ligament reconstruction.
Methods
A prospective, randomized, controlled study comparing computer navigation with manual
operation was performed between December 2003 and April 2004. We assigned 20 patients
to the computer navigation group and 20 patients to the manual navigation group. Surgery
was performed by use of a patellar tendon autograft with press-fit fixation. A lateral
radiograph of the knee at maximum extension was used to determine the exact position
of the tibial tunnel at 4 days postoperatively. Outcomes were evaluated with International
Knee Documentation Committee 2000, Tegner, and Lysholm scoring. There was an additional
magnetic resonance imaging (MRI) evaluation of tunnel placement and graft quality
at the most recent follow-up, approximately 24 months after surgery.
Results
The postoperative radiographs and 2-year postoperative MRI scans showed no differences
between groups for tibial or femoral tunnel placement. In both groups the mean tibial
tunnel placement was 46% of the maximal diameter of the tibia. There were no significant
differences between groups for objective and subjective outcomes scoring. Although
some qualitative differences existed between groups with respect to MRI graft appearance
at 2 years, this had no correlation with overall results.
Conclusions
No significant differences were found between computer-assisted and manually navigated
anterior cruciate ligament reconstruction with regard to tunnel placement and clinical
results at a mean of 2 years postoperatively.
Level of Evidence
Level I, randomized, single-blinded, controlled trial.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Matava MJ, Boden BP, eds. AOSSM initiates multi-center ACL revision study. Sports Medicine Update 2005:5. Available from: http://www.sportsmed.org/tabs/resources/smupdate.aspx. Accessed June 2005.
- Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: A randomized study with a long-term follow-up period.Clin Orthop Relat Res. 1991; : 255-263
- Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament.J Bone Joint Surg Am. 1993; 73: 278-286
- Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts.J Bone Joint Surg Am. 1993; 75: 1346-1355
- A comparison of results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes.Scand J Med Sci Sports. 1999; 9: 290-295
- Differences in the placement of the tibial tunnel during reconstruction of the anterior cruciate ligament with and without computer assisted navigation.Am J Sports Med. 2007; 35: 1824-1832
- Precision of ACL tunnel placement using traditional and robotic techniques.Comput Aided Surg. 2001; 6: 270-278
- Computer-navigated ACL reconstruction with the OrthoPilot.Surg Technol Int. 2004; 12: 245-251
- Computer assisted orthopaedic surgery.Clin Orthop Relat Res. 1998; : 8-16
- Computer assistance in arthroscopic anterior cruciate ligament reconstruction.Clin Orthop Relat Res. 1998; : 65-69
- Accuracy in tunnel placement for ACL reconstruction.Comput Aided Surg. 2001; 6: 279-289
- Tibial attachment area of the anterior cruciate ligament in the extended knee position.Knee Surg Sports Traumatol Arthrosc. 1994; 2: 138-146
- Femoral insertion of the ACL.Am J Knee Surg. 1997; 10: 14-21
- Appearance of the patellar tendon graft and correlation with arthroscopy in sportsmen after ACL reconstruction in lowfield-MRI.Dtsch Z Sportmed. 2002; 2 (in German): 49-53
- Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament.Knee Surg Sports Traumatol Arthrosc. 1998; 6: 49-55
- Positioning of the tibial tunnel for anterior cruciate ligament reconstruction.Arthroscopy. 1995; 11: 688-695
- Precision in reconstruction of the anterior cruciate ligament.Acta Orthop Scand. 1987; 58: 658-661
- Anterior cruciate ligament reconstruction.Am J Sports Med. 1992; 21: 415-418
- Intersurgeon variance in computer-assisted planning of anterior cruciate ligament reconstruction.Arthroscopy. 2005; 21: 942-947
- Serial magnetic resonance imaging of hamstring anterior cruciate ligament autografts during the first year of implantation.Am J Sports Med. 1991; 19: 42-47
- MRI of anterior cruciate ligament repair with patellar and hamstring tendon autografts.Skeletal Radiol. 2001; 30: 8-14
- Synovial healing in reconstructed cruciate ligaments.Radiol Med. 1999; 98: 454-461
- Unimpinged and impinged anterior cruciate ligament grafts: MR signal intensity measurements.Radiology. 1991; 179: 639-643
- Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: A 5-year follow-up.Arthroscopy. 2001; 17: 9-13
- Central third bone-patellar tendon-bone anterior cruciate ligament reconstruction: A 5-year follow-up.Arthroscopy. 2000; 16: 67-70
- Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction.Am J Sports Med. 1994; 22: 211-217
Article info
Publication history
Accepted:
May 23,
2009
Received:
August 8,
2008
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
