Comparison of intraoperative effects of computer navigation-assisted and simple arthroscopic reconstruction of posterior cruciate ligament tibial tunnel_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QU Di ¹ , ZHANG Jing ¹ , LI Liping ² , FU Haitao ³ , ZHANG Dongfang ³ , TANG Xinyu ¹ , HAN Xinkun ¹ ,  QI Chao ³

1. Qingdao Medical College of Qingdao University, Qingdao Shandong, 266073, P. R. China;
2. Department of Orthopedic Surgery, Qingdao Central Hospital, Qingdao Shandong, 266042, P. R. China;
3. Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China;

Corresponding author：

QI Chao, Email: qichao2002@163.com

Keywords：

Posterior cruciate ligament reconstruction; computer navigation; arthroscopy; tibial tunnel

DOI：

10.7507/1002-1892.202311012

Video：

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Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant (P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups (P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group (P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values (P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups (P>0.05). Conclusion Computer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.

Citation： QU Di, ZHANG Jing, LI Liping, FU Haitao, ZHANG Dongfang, TANG Xinyu, HAN Xinkun, QI Chao. Comparison of intraoperative effects of computer navigation-assisted and simple arthroscopic reconstruction of posterior cruciate ligament tibial tunnel. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(2): 155-161. doi: 10.7507/1002-1892.202311012 Copy

1.	Kennedy NI, Wijdicks CA, Goldsmith MT, et al. Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med, 2013, 41(12): 2828-2838.
2.	Logterman SL, Wydra FB, Frank RM. Posterior cruciate ligament: Anatomy and biomechanics. Curr Rev Musculoskelet Med, 2018, 11(3): 510-514.
3.	Schulz MS, Russe K, Weiler A, et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg, 2003, 123(4): 186-191.
4.	Schlumberger M, Schuster P, Eichinger M, et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2091-2098.
5.	Sanders TL, Pareek A, Barrett IJ, et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3017-3023.
6.	Lee DW, Kim JG, Yang SJ, et al. Return to sports and clinical outcomes after arthroscopic anatomic posterior cruciate ligament reconstruction with remnant preservation. Arthroscopy, 2019, 35(9): 2658-2668.
7.	Gill TJ, DeFrate LE, Wang C, et al. The effect of posterior cruciate ligament reconstruction on patellofemoral contact pressures in the knee joint under simulated muscle loads. Am J Sports Med, 2004, 32(1): 109-115.
8.	Yavari E, Moosa S, Cohen D, et al. Technology-assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(10): 4299-4311.
9.	胡鹏宇, 余志平, 刘端正, 等. 电磁导航系统辅助后交叉韧带重建胫骨隧道定位的效果评价. 实用骨科杂志, 2020, 26(8): 703-706.
10.	熊健斌, 赵劲民, 沙轲, 等. 计算机导航技术在后交叉韧带重建胫骨隧道定位中的应用. 中国组织工程研究与临床康复, 2011, 15(17): 3139-3142.
11.	冯华, 洪雷, 王雪松, 等. 计算机导航技术辅助后交叉韧带重建中胫骨隧道定位. 中国运动医学杂志, 2007, 26(4): 432-437.
12.	Greiner P, Magnussen RA, Lustig S, et al. Computed tomography evaluation of the femoral and tibial attachments of the posterior cruciate ligament in vitro. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1876-1883.
13.	Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(11): S208-S228.
14.	Dessenne V, Lavallée S, Julliard R, et al. Computer-assisted knee anterior cruciate ligament reconstruction: first clinical tests. J Image Guid Surg, 1995, 1(1): 59-64.
15.	Figueroa F, Figueroa D, Guiloff R, et al. Navigation in anterior cruciate ligament reconstruction: State of the art. J ISAKOS, 2023, 8(1): 47-53.
16.	Okoroafor UC, Saint-Preux F, Gill SW, et al. Nonanatomic tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction leads to greater posterior tibial translation in a biomechanical model. Arthroscopy, 2016, 32(7): 1354-1358.
17.	Lee DY, Kim DH, Kim HJ, et al. Posterior cruciate ligament reconstruction with transtibial or tibial inlay techniques: A meta-analysis of biomechanical and clinical outcomes. Am J Sports Med, 2018, 46(11): 2789-2797.
18.	Huang TW, Wang CJ, Weng LH, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction. Arthroscopy, 2003, 19(7): 712-716.
19.	Kim SJ, Chang JH, Kang YH, et al. Clinical comparison of anteromedial versus anterolateral tibial tunnel direction for transtibial posterior cruciate ligament reconstruction: 2 to 8 years’ follow-up. Am J Sports Med, 2009, 37(4): 693-698.
20.	Song EK, Park HW, Ahn YS, et al. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med, 2014, 42(12): 2964-2971.
21.	Weimann A, Wolfert A, Zantop T, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture. Arthroscopy, 2007, 23(10): 1104-1111.
22.	Karkenny AJ, Mendelis JR, Geller DS, et al. The role of intraoperative navigation in orthopaedic surgery. J Am Acad Orthop Surg, 2019, 27(19): e849-e858.
23.	Foo WYX, Chou ACC, Lie HM, et al. Computer-assisted navigation in ACL reconstruction improves anatomic tunnel placement with similar clinical outcomes. Knee, 2022, 38: 132-140.

1. Kennedy NI, Wijdicks CA, Goldsmith MT, et al. Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med, 2013, 41(12): 2828-2838.
2. Logterman SL, Wydra FB, Frank RM. Posterior cruciate ligament: Anatomy and biomechanics. Curr Rev Musculoskelet Med, 2018, 11(3): 510-514.
3. Schulz MS, Russe K, Weiler A, et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg, 2003, 123(4): 186-191.
4. Schlumberger M, Schuster P, Eichinger M, et al. Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2091-2098.
5. Sanders TL, Pareek A, Barrett IJ, et al. Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3017-3023.
6. Lee DW, Kim JG, Yang SJ, et al. Return to sports and clinical outcomes after arthroscopic anatomic posterior cruciate ligament reconstruction with remnant preservation. Arthroscopy, 2019, 35(9): 2658-2668.
7. Gill TJ, DeFrate LE, Wang C, et al. The effect of posterior cruciate ligament reconstruction on patellofemoral contact pressures in the knee joint under simulated muscle loads. Am J Sports Med, 2004, 32(1): 109-115.
8. Yavari E, Moosa S, Cohen D, et al. Technology-assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(10): 4299-4311.
9. 胡鹏宇, 余志平, 刘端正, 等. 电磁导航系统辅助后交叉韧带重建胫骨隧道定位的效果评价. 实用骨科杂志, 2020, 26(8): 703-706.
10. 熊健斌, 赵劲民, 沙轲, 等. 计算机导航技术在后交叉韧带重建胫骨隧道定位中的应用. 中国组织工程研究与临床康复, 2011, 15(17): 3139-3142.
11. 冯华, 洪雷, 王雪松, 等. 计算机导航技术辅助后交叉韧带重建中胫骨隧道定位. 中国运动医学杂志, 2007, 26(4): 432-437.
12. Greiner P, Magnussen RA, Lustig S, et al. Computed tomography evaluation of the femoral and tibial attachments of the posterior cruciate ligament in vitro. Knee Surg Sports Traumatol Arthrosc, 2011, 19(11): 1876-1883.
13. Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11(11): S208-S228.
14. Dessenne V, Lavallée S, Julliard R, et al. Computer-assisted knee anterior cruciate ligament reconstruction: first clinical tests. J Image Guid Surg, 1995, 1(1): 59-64.
15. Figueroa F, Figueroa D, Guiloff R, et al. Navigation in anterior cruciate ligament reconstruction: State of the art. J ISAKOS, 2023, 8(1): 47-53.
16. Okoroafor UC, Saint-Preux F, Gill SW, et al. Nonanatomic tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction leads to greater posterior tibial translation in a biomechanical model. Arthroscopy, 2016, 32(7): 1354-1358.
17. Lee DY, Kim DH, Kim HJ, et al. Posterior cruciate ligament reconstruction with transtibial or tibial inlay techniques: A meta-analysis of biomechanical and clinical outcomes. Am J Sports Med, 2018, 46(11): 2789-2797.
18. Huang TW, Wang CJ, Weng LH, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction. Arthroscopy, 2003, 19(7): 712-716.
19. Kim SJ, Chang JH, Kang YH, et al. Clinical comparison of anteromedial versus anterolateral tibial tunnel direction for transtibial posterior cruciate ligament reconstruction: 2 to 8 years’ follow-up. Am J Sports Med, 2009, 37(4): 693-698.
20. Song EK, Park HW, Ahn YS, et al. Transtibial versus tibial inlay techniques for posterior cruciate ligament reconstruction: long-term follow-up study. Am J Sports Med, 2014, 42(12): 2964-2971.
21. Weimann A, Wolfert A, Zantop T, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture. Arthroscopy, 2007, 23(10): 1104-1111.
22. Karkenny AJ, Mendelis JR, Geller DS, et al. The role of intraoperative navigation in orthopaedic surgery. J Am Acad Orthop Surg, 2019, 27(19): e849-e858.
23. Foo WYX, Chou ACC, Lie HM, et al. Computer-assisted navigation in ACL reconstruction improves anatomic tunnel placement with similar clinical outcomes. Knee, 2022, 38: 132-140.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of intraoperative effects of computer navigation-assisted and simple arthroscopic reconstruction of posterior cruciate ligament tibial tunnel

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