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Clinical advantages of image-free navigation system using surface-based registration in anatomical anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR).

Methods

Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group). The position/orientation information of tunnel entry point, tunnel length, and posterior wall distance of pre-, intra-, and postoperative tunnel were recorded, and the reliability and errors among them were evaluated.

Results

From comparison of the 3D models for preoperative planning and postoperative reconstruction, the mean differences for navigational femoral tunnelling and arthroscopic-assisted femoral tunnelling were recorded, respectively: (1) tunnel entry position, 1.4 mm (SD 0.3) versus 4.9 mm; (2) tunnel length, 0.7 mm (SD 0.2), similar to 0.6 mm in arthroscopic-assisted femoral tunnelling, and (3) posterior wall distance, 0.5 mm (SD 0.2), much smaller than 4.7 mm for arthroscopic-assisted femoral tunnelling. The intraclass correlation coefficients, calculated to determine the accuracy and reliability of navigational femoral tunnelling, showed excellent internal consistency that ranged from 0.965 to 0.989 for tunnel length and from 0.810 to 0.953 for posterior wall distance.

Conclusion

Navigation systems with enhancement of the registration accuracy by the developed system are feasible in anatomical ACLR, in reducing surgical failures such as short tunnel length or posterior wall breakage of distal femur. The present study revealed that computer navigation could aid in avoiding major mistakes in exact positioning and posterior wall blowout and help in attaining appropriate length for femoral tunnelling in anatomical ACLR.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea

    Byung Hoon Lee

  2. Department of Anatomy, College of Medicine, Korea University, Seoul, South Korea

    Im Joo Rhyu

  3. Center for Bionics, Korea Institute of Science and Technology, Seoul, South Korea

    Youngjun Kim & Hyunchul Cho

  4. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea

    Dong Ho Kum & Joon Ho Wang

Authors
  1. Byung Hoon Lee
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  2. Dong Ho Kum
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  4. Youngjun Kim
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  5. Hyunchul Cho
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Corresponding author

Correspondence to Joon Ho Wang.

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Conflict of interest

The authors have no conflict of interest to declare. Dr. BH Lee, DH Kum and JH Wang have no conflicts of interest or financial ties to disclose. Y Kim and H Cho work as a PhD. researcher at the KIST (Korea Institute of Science and Technology) and Dr. IJ Rhyu is a consultant for cadaveric experiments. None of the authors received financial support for this study.

Funding

This work was supported by a grant of the 2014 SMC-KIST Translational Research Program (SMX1140101). The funding sources had no involvement in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or in the decision to submit the manuscript for publication.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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No informed consent was necessary for the study.

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Lee, B.H., Kum, D.H., Rhyu, I.J. et al. Clinical advantages of image-free navigation system using surface-based registration in anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24, 3556–3564 (2016). https://doi.org/10.1007/s00167-016-4332-6

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