Navigated Anterior Cruciate Ligament Reconstruction: Radiographic Validation of a Nonimage-based System

Abstract

The authors compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted anterior cruciate ligament reconstruction to the postoperative measurements performed on standard plain radiographs in 56 patients. The position of the center of the tibial and femoral tunnels was measured intraoperatively with the OrthoPilot (B. Braun Aesculap, Tuttlingen, Germany) and postoperatively on plain anteroposterior and lateral radiographs. The center of the tibial tunnel was located at 43% of the mediolateral tibial dimension intraoperatively and at 41% of the mediolateral tibial dimension postoperatively (P=.14). The center of the tibial tunnel tibial was located at 40% of the anteroposterior tibial dimension intraoperatively and at 35% of the anteroposterior tibial dimension postoperatively (P=.01). The center of the femoral tunnel was located at 85% of the anteroposterior femoral dimension intraoperatively and at 76% of the anteroposterior femoral dimension postoperatively (P<.001). A significant correlation was found between intraoperative navigated and postoperative radiographic measurements only at the femur. Good agreement existed between all navigated and radiographic measurements. The OrthoPilot navigation system allows an accurate measurement of the location of the tibial and femoral tunnels during anterior cruciate ligament reconstruction.

An ACL reconstruction robotic positioning system based on anatomical characteristics

“…Visual tracking errors, criterions of standard AP and LAT view, manual point-selection errors in preoperative and intraoperative images, and other factors may have an influence on the positioning accuracy. The positioning precision of tunnels using ACL-RRPS-AC is not as good as that using point cloud-based systems, 9 –12 which range from 1 mm to 1.5 mm. But it is below 3 mm, which can meet the clinical requirements.…”

“…These navigation systems can be classified into three types: point cloud based, 3-D printing based, and intraoperative X-ray image based. (1) KneeNav 9 developed by Medical Center of Pittsburgh University and Carnegie Mellon University, OrthoPilot developed by Tuttlingen corporation in Germany, 10 Bone Morping 11 developed by Praxim in France, and an image-free navigation system developed by Beihang University 12 are all point cloud-based system. In point cloud-based system, intraoperative anatomical features are collected by a probe which would result in additional trauma.…”

Effects of extremity positioning on radiographic evaluation of femoral tunnel location with digitally reconstructed femoral lateral radiographs after anterior cruciate ligament reconstruction

“…This study defined the radiographic locations of the femoral and tibial bundle attachment sites of the native ACL and also defined a reliable and transferable protocol for identifying these sites on radiographs in relation to surrounding landmarks and digitally projected reference lines. Jenny et al [ 22 ] compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted ACL reconstruction to the postoperative measurements performed on standard plain antero-posterior and lateral radiographs. They found significant correlation between intraoperative navigated and postoperative radiographic measurements only at the femur and good agreement between all navigated and radiographic measurements.…”

“…Hence, it is envisaged that 2D-radiography is less accurate than 3D-imaging techniques. However a few recent studies suggest similar levels of accuracy with 2D-radiography and 3D-imaging or intraoperative techniques in assessing tunnel/graft position [ 11 , 19 – 22 ]. There are very few studies evaluating tunnel placement by radiographs in anatomic single-bundle ACL reconstruction [ 19 , 23 ].…”

Intensity‐based 2D‐3D registration for an ACL reconstruction navigation system

“…All previous navigation systems were based on an anatomical‐feature‐based registration. Intraoperative anatomical features were collected by a probe, which would result in additional trauma. Because soft tissues were stuck on the surface of bone, it was difficult to collect an ideal point cloud from the knee, which made the registration of preoperative space and intraoperative space inaccurate.…”