EFFECTIVENESS OF COMPUTER-ASSISTED PREOPERATIVE PLANNING SYSTEM IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

1Department of Sports Medicine, 2Department of Medical Imageology, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China. Corresponding author: LI Yanlin, E-mail: 852387873@qq.com;

Corresponding author：

Keywords：

Computer-assisted technology; Preoperative planning; Anterior cruciate; ligament reconstruction

DOI：

10.7507/1002-1892.20130314

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Objective To evaluate the feasibility and effectiveness of computer-assisted preoperative planning system—ACL Detector in anterior cruciate ligament (ACL) reconstruction. Methods Between March 2009 and January 2012, 80 patients with ACL rupture received arthroscopic ACL single-bundle reconstruction with autologous hamstring tendon transplantation. Before operation, the preoperative planning was done by computer-assisted preoperative planning system—ACL Detector (trial group, n=40) or by conventional method (control group, n=40). There was no significant difference in gender, age, disease duration, injury cause, preoperative Lysholm score, and preoperative International Knee Documentation Committee (IKDC) score between 2 groups (P gt; 0.05). After operation, the effectiveness was evaluated by Lachman test, pivot shift test, Lysholm score, and IKDC score; the digital three-dimensinal model of knee was reconstructed, and the impingement rate of ACL graft was measured. Results All incisions healed by first intention, and no complication was found. The patients were followed up 18-25 months (mean, 20 months) in trial group and 18-24 months (mean, 21 months) in control group. The Lysholm score and IKDC score were significantly increased at 18 months after operation when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups (P gt; 0.05). The results of Lachman test and pivot shift test at 18 months after operation were significantly better than those before operation in 2 groups (P lt; 0.05), but no significant difference between 2 groups after operation (P gt; 0.05). MRI showed that impingement was observed in 1 case of trial group (2.50%) and in 8 cases of control group (20.00%), showing significant difference (χ2=4.51, P=0.03). Conclusion The computer-assisted preoperative planning system—ACL Detector could be successfully applied to ACL reconstruction. It has the same improvement in knee functional score as conventional surgery, but it is better than conventional surgery in reducing the impingement incidence.

Citation： HE Chuan,LI Yanlin,ZHANG Zhenguang,WANG Guoliang,WANG Fuke,CAO Shuhai,WANG Huijian ZHAO Fengkai. EFFECTIVENESS OF COMPUTER-ASSISTED PREOPERATIVE PLANNING SYSTEM IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1432-1436. doi: 10.7507/1002-1892.20130314 Copy

1.	Petersen W, Forkel P, Achtnich A, et al. Anatomic reconstruction of the anterior cruciate ligament in single bundle technique. Oper Orthop Traumatol, 2013, 25 (2): 185-204.
2.	Herbort M, Lenschow S, Fu FH, et al. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 1551-1558.
3.	Fu FH, Musahi V. Anatomic ACL reconstruction. Preface. Clin Sports Med, 2013, 32 (1): XV-XVI.
4.	Hara K, Mochizuki T, Sekiya I, et al. Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med, 2009, 37(12): 2386-2391.
5.	Plaweski S, Rossi J, Merloz P, et al. Analysis of anatomic positioning in computer-assisted and conventional anterior cruciate ligament reconstruction. Orthopaedics & Traumatology, 2011, 97: S80-S85.
6.	Shafizadeh S, Balke M, Wegener S, et al. Precision of tunnel positioning in navigated anterior cruciate ligament reconstruction. Arthroscopy, 2011, 27(9): 1268-1274.
7.	Kawakami Y, Hiranaka T, Matsumoto T, et al. The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1503-1510.
8.	Pietrini SD, Ziegler CG, Anderson CJ, et al. Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2011, 19(5): 792-800.
9.	Swami VG, Cheng-Baron J, Hui C, et al. Reliability of estimates of ACL attachment locations in 3-dimensional knee reconstruction based on routine clinical MRI in pediatric patients. Am J Sports Med, 2013, 41(6): 1319-1329.
10.	Forsythe B, Kopf S, Wong AK, et al. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg (Am), 2010, 92(6): 1418-1426.
11.	Xerogeanes JW, Hammond KE, Todd DC. Anatomic landmarks utilized for physeal-sparing, anatomic anterior cruciate ligament reconstruction: an MRI-based study. J Bone Joint Surg (Am), 2012, 94(3): 268-276.
12.	李彦林, 许鹏, 韩睿, 等. 基于MRI二维影像下股骨髁间窝的三维可视化研究. 中国修复重建外科杂志, 2012, 26(10): 1182-1186.
13.	Zhu W, Lu W, Han Y, et al. Application of a computerised navigation technique to assist arthroscopic anterior cruciate ligament reconstruction. Int Orthop, 2013, 37(2): 233-238.
14.	Zaffagnini S, Klos TV, Bignozzi S. Computer-assisted anterior cruciate ligament reconstruction: an evidence-based approach of the first 15 years. Arthroscopy, 2010, 26(4): 546-554.
15.	Voos JE, Musahl V, Maak TG, et al. Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1282-1289.
16.	Cheng T, Zhang GY, Zhang XL, et al. Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials. Knee, 2012, 19(2): 73-77.
17.	Anthony CA, Duchman K, McCunniff P, et al. Double-bundle ACL reconstruction: Novice surgeons utilizing computer-assisted versus experienced surgeons. Comput Aided Surg, 2013, 18(5-6): 172-180.
18.	Cheng T, Liu T, Zhang G, et al. Computer-navigated surgery in anterior cruciate ligament reconstruction: are radiographic outcomes better than conventional surgery? Arthroscopy, 2011, 27(1): 97-100.
19.	Ohkawa S, Adachi N, Deie M, et al. The relationship of anterior and rotatory laxity between surgical navigation and clinical outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(4): 778-784.
20.	Meuffels DE, Potters JW, Koning AH, et al. Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images. Acta Orthop, 2011, 82(6): 699-703.

1. Petersen W, Forkel P, Achtnich A, et al. Anatomic reconstruction of the anterior cruciate ligament in single bundle technique. Oper Orthop Traumatol, 2013, 25 (2): 185-204.
2. Herbort M, Lenschow S, Fu FH, et al. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc, 2010, 18(11): 1551-1558.
3. Fu FH, Musahi V. Anatomic ACL reconstruction. Preface. Clin Sports Med, 2013, 32 (1): XV-XVI.
4. Hara K, Mochizuki T, Sekiya I, et al. Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med, 2009, 37(12): 2386-2391.
5. Plaweski S, Rossi J, Merloz P, et al. Analysis of anatomic positioning in computer-assisted and conventional anterior cruciate ligament reconstruction. Orthopaedics & Traumatology, 2011, 97: S80-S85.
6. Shafizadeh S, Balke M, Wegener S, et al. Precision of tunnel positioning in navigated anterior cruciate ligament reconstruction. Arthroscopy, 2011, 27(9): 1268-1274.
7. Kawakami Y, Hiranaka T, Matsumoto T, et al. The accuracy of bone tunnel position using fluoroscopic-based navigation system in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1503-1510.
8. Pietrini SD, Ziegler CG, Anderson CJ, et al. Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2011, 19(5): 792-800.
9. Swami VG, Cheng-Baron J, Hui C, et al. Reliability of estimates of ACL attachment locations in 3-dimensional knee reconstruction based on routine clinical MRI in pediatric patients. Am J Sports Med, 2013, 41(6): 1319-1329.
10. Forsythe B, Kopf S, Wong AK, et al. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg (Am), 2010, 92(6): 1418-1426.
11. Xerogeanes JW, Hammond KE, Todd DC. Anatomic landmarks utilized for physeal-sparing, anatomic anterior cruciate ligament reconstruction: an MRI-based study. J Bone Joint Surg (Am), 2012, 94(3): 268-276.
12. 李彦林, 许鹏, 韩睿, 等. 基于MRI二维影像下股骨髁间窝的三维可视化研究. 中国修复重建外科杂志, 2012, 26(10): 1182-1186.
13. Zhu W, Lu W, Han Y, et al. Application of a computerised navigation technique to assist arthroscopic anterior cruciate ligament reconstruction. Int Orthop, 2013, 37(2): 233-238.
14. Zaffagnini S, Klos TV, Bignozzi S. Computer-assisted anterior cruciate ligament reconstruction: an evidence-based approach of the first 15 years. Arthroscopy, 2010, 26(4): 546-554.
15. Voos JE, Musahl V, Maak TG, et al. Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1282-1289.
16. Cheng T, Zhang GY, Zhang XL, et al. Does computer navigation system really improve early clinical outcomes after anterior cruciate ligament reconstruction? A meta-analysis and systematic review of randomized controlled trials. Knee, 2012, 19(2): 73-77.
17. Anthony CA, Duchman K, McCunniff P, et al. Double-bundle ACL reconstruction: Novice surgeons utilizing computer-assisted versus experienced surgeons. Comput Aided Surg, 2013, 18(5-6): 172-180.
18. Cheng T, Liu T, Zhang G, et al. Computer-navigated surgery in anterior cruciate ligament reconstruction: are radiographic outcomes better than conventional surgery? Arthroscopy, 2011, 27(1): 97-100.
19. Ohkawa S, Adachi N, Deie M, et al. The relationship of anterior and rotatory laxity between surgical navigation and clinical outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(4): 778-784.
20. Meuffels DE, Potters JW, Koning AH, et al. Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: reliability of standard radiographs, CT scans, and 3D virtual reality images. Acta Orthop, 2011, 82(6): 699-703.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF COMPUTER-ASSISTED PREOPERATIVE PLANNING SYSTEM IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

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