Endoscopic anterior cruciate ligament reconstruction using a computer-assisted fluoroscopic navigation system

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Accurate placement of the reconstructed ligament is crucial for successful anterior cruciate ligament (ACL) reconstruction outcomes.
• Traditional methods may be limited by patient skeletal variations.
• Endoscopic ACL reconstruction necessitates precise bone tunnel positioning.

Purpose of the Study:

• To evaluate the precision of tibial tunnel placement using a fluoroscopic navigation system in endoscopic ACL reconstruction.
• To compare the accuracy of tibial tunnel placement with and without navigation assistance.
• To discuss the advantages and disadvantages of fluoroscopic navigation for ACL surgery.

Main Methods:

• 16 patients undergoing ACL reconstruction with a fluoroscopic navigation system (navi group) were assessed.
• Tibial tunnel positioning relative to Blumensaat's line was evaluated using X-ray.
• Graft placement was visualized using magnetic resonance imaging (MRI).
• A control group (16 patients) underwent ACL reconstruction without navigation.

Main Results:

• The navi group showed improved tibial tunnel alignment with Blumensaat's line (2.7% +/- 3.4% distance ratio) compared to the control group (8.4% +/- 7.4%).
• Roof impingement was avoided, and grafts were positioned parallel to the intercondylar roof in the navi group.
• The navigation system demonstrated high accuracy in tibial tunnel placement.

Conclusions:

• Computer-assisted fluoroscopic navigation enhances accuracy and reduces variability in tibial tunnel placement for single-bundle ACL reconstruction.
• The system offers a more reliable procedure, mitigating issues related to patient skeletal differences.
• Current limitations exist in femoral tunnel placement, necessitating further system refinement and improved application methods.