Accuracy in Tunnel Placement for ACL Reconstruction. Comparison of Traditional Arthroscopic and Computer-Assisted Navigation Techniques

Abstract

The purpose of this randomized, prospective study was to compare accuracy in runnel placement as performed with a traditional arthroscopic anterior cruciate ligament (ACL) reconstruction technique and with KneeNav™ ACL, a computer-assisted surgical navigation technique. Two surgeons experienced in ACL reconstruction, but inexperienced in computer-assisted surgical navigation technique, each randomly used traditional arthroscopic guides or KneeNav™ ACL to drill a tunnel in twenty identical foam knees. Placement of the resulting tibial and femoral tunnels was measured with a computer-assisted digitizing method and compared to traditional biplanar radiographs. Statistical analysis with Student's t-test was used to compare the distance from the ideal tunnel placement to the femoral and tibial tunnels. Accuracy of tunnel placement with KneeNav™ ACL was significantly better than that obtained with the traditional arthroscopic technique. Distances from the ideal tunnel placement to the femoral and tibial tunnels were 4.2 ± 1.8 mm (mean ± SD) and 4.9 ± 2.3 mm, respectively, for the traditional arthroscopic technique, and 2.7 ± 1.9 mm (femur) and 3.4 ± 2.3 mm (tibia) for KneeNav™ ACL. These differences were statistically different. Tunnel placement for ACL reconstruction with KneeNav™ ACL, an image-based, computer-assisted surgical navigation device with a simple and intuitive interface, was more accurate than with the traditional arthroscopic technique.