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Computer-assisted surgery for knee ligament reconstruction.

Vincent Eggerding1, Max Reijman, Rob J P M Scholten

  • 1Department of Orthopaedics, Erasmus MC, University Medical Center, 's Gravendijkwal 230, Rotterdam, Netherlands, 3000 CA.

The Cochrane Database of Systematic Reviews
|August 5, 2014
PubMed
Summary

Computer-assisted surgery (CAS) for anterior or posterior cruciate ligament (ACL/PCL) reconstruction does not show improved outcomes compared to conventional techniques. Current evidence is insufficient to demonstrate a benefit, highlighting the need for better study reporting.

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Area of Science:

  • Orthopaedic Surgery
  • Biomedical Engineering
  • Clinical Trials

Background:

  • Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, with graft malpositioning being a frequent cause of failure.
  • Computer-assisted surgery (CAS) aims to enhance graft placement accuracy in ACL and posterior cruciate ligament (PCL) reconstructions.
  • This review is an update of previous Cochrane reviews on CAS for cruciate ligament reconstruction, first published in 2011.

Purpose of the Study:

  • To evaluate the effectiveness of computer-assisted surgery (CAS) versus conventional surgical techniques for adult ACL or PCL injuries.
  • To assess the impact of CAS on graft placement accuracy and patient outcomes in knee ligament reconstructions.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs comparing CAS with conventional surgery for ACL/PCL reconstruction.
  • Searched multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL) from 2010 to July 2013.
  • Data extraction and risk of bias assessment by two independent authors; pooled data using risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI).

Main Results:

  • Five RCTs with 366 participants (70% female, ages 14-53) were included, all involving ACL reconstructions.
  • Moderate-quality evidence showed no clinically relevant difference in International Knee Documentation Committee (IKDC) subjective scores between CAS and conventional surgery.
  • Low to very low-quality evidence indicated no significant differences in Lysholm scores, Tegner scores, knee stability, range of motion, or tunnel placement. CAS was associated with longer operating times (9-27 minutes).

Conclusions:

  • The available evidence does not demonstrate a favorable effect of CAS for cruciate ligament reconstructions compared to conventional methods.
  • Current evidence does not indicate that CAS improves patient outcomes in knee ligament reconstruction.
  • There is a need for improved reporting standards in future studies evaluating CAS technology.