2015 ISAKOS Biennial Congress ePoster #1379

Only Navigation Guided Anatomical Anterior Cruciate Ligament Reconstruction - 20 Cadaveric Study

Sin Hyung Park, MD, Seoul KOREA, REPUBLIC OF
Sang Won Moon, MD, Busan KOREA, REPUBLIC OF
Byung-Hoon Lee, MD, PhD, Incheon KOREA, REPUBLIC OF
Sehyung Park, PhD, Seoul KOREA, REPUBLIC OF
Sunghwan Lim, PhD, Seoul KOREA, REPUBLIC OF
Jin-Hwan Ahn, MD, Seoul KOREA, REPUBLIC OF
Joon Ho Wang, MD, PhD, Seoul KOREA, REPUBLIC OF
Samsung Medical center, Seoul, KOREA

FDA Status Cleared

Summary: Only navigation guided ACL reconstruction by our developed planning and navigation system showed consistent results in making femoral tunnel position and orientation, and the accuracy and consistency of femoral tunneling can be improved by the use of pre-operative planning and navigation system.

Abstract:

Introduction

Recently, as importance of anatomic position in anterior cruciate ligament reconstruction(ACL) is emphasized, transportal or outside-in technique is considered to proper technique. However, it is difficult to find out the exact position during the arthroscopic surgery. Computer-assisted surgery has been developed to improve the accuracy and reproducibility of the surgical procedure in sports medicine field and it can improve the accuracy of tunnel placement in anatomical ACL reconstruction surgery.
The purpose of this study was to make navigation system for anatomic ACL reconstruction and to evaluate the accuracy of this system by comparing pre-op planning and post-op tunnel orientation after only navigation guide ACL reconstruction.

Methods

3D preoperative planning software was developed by open source libraries. To determine a femoral insertion position, radiographic quadrant method by Bernard was used. After insertion point was determined, tunneling pathway is displayed and tunnel information can be calculated including tunnel length, distance between tunnel and posterior cortex, and distance between two tunnels.
Twenty knees of ten fresh frozen human cadaver was underwent an only navigation guided double-bundle ACL reconstruction using trans-portal technique. Computed tomography(CT) scan was performed after ACL reconstruction. 3D surface model of distal femur was made using axial image of CT scan.
We evaluated the femoral tunnel position by Bernard’ quadrant method, the femoral tunnel orientation by measuring the tunnel angle in three projected planes, and the incidence of posterior cortical damage. Then we compared the pre-operative planning between the post-operative results.

Results

In femoral tunnel position, Mean x value and y value of AM tunnel was 28.2%±0.8(27-30), 20.8%±2.9(15-24) in pre-operative planning and 28.8%±6.2(20-40), 24.3%±7.5(13-40) in post-operative result. Mean x value and y value in PL tunnel was 34.0%±3.0(30-40), 49.8%±1.5(48-53) in pre-operative planning and 33.3%±6.1(25-40), 48.8%±8.7(37-62) in post-operative result.
In femoral tunnel orientation, mean coronal angle, axial angle and sagittal angle of AM tunnel was 51.0°±3.4(47-57), 34.9°±8.8(17-50), 55.1°±7.6(45-68) in pre-operative planning and 48.9°±7.6(37-58), 30.9°±7.0(23-41), 57.0°±12.1(37-77 in post-operative result. Mean coronal angle, axial angle and sagittal angle of PL tunnel was 46.3°±3.9(39-51), 28.9°±9.9(12-43), 57.3°±9.4(45-72) in pre-operative planning and 44.3°±5.2(37-54), 25.6°±8.5(15-40), 58.0°±12.6(37-77) in post-operative result. There was no significant difference in pre-operative planning and post-operative results.
Posterior cortical damage developed in 7 cases (35%).

Conclusion

Only navigation guided ACL reconstruction by our developed planning and navigation system showed consistent results in making femoral tunnel position and orientation. The accuracy and consistency of femoral tunneling can be improved by the use of pre-operative planning and navigation system.