Abstract
To improve the positioning accuracy of tunnels for anterior cruciate ligament (ACL) reconstruction, we proposed an ACL reconstruction robotic positioning system based on anatomical characteristics. The system includes a preoperative path planning system, an intraoperative path planning system, and a navigation and positioning system. Brahmet line, anterior, and posterior cortical lines are used for registration of preoperative computed tomography (CT) images and intraoperative X-ray images. A new calibrator of C-arm is applied to establish the mapping between medical images and surgical space. Tunnels for ACL reconstruction can be built anatomically by the robot. The accuracy of the path planning system is 1.73 mm in the four dry bones experiments and 2.17 mm in the two cadaver experiments. The accuracy meets the accuracy requirement of ACL construction surgery.
Highlights
Precise positioning of femoral and tibial tunnel is the key to anterior cruciate ligament (ACL) reconstruction
P denotes position of path planning system using computed tomography (CT) data; (2) intraoperative standard AP and LAT X-ray images of femur and tibia are captured and rectified; (3) femoral and tibial end points are planned in rectified images; (4) C-arm are calibrated by the method in the “Calibration of C-arm” section; (5) coordinates of end points in robot system are calculated by the method in the “An ACL RRPS” section; (6) robot arm moves the planning positions; and (7) errors of end points at AP and LAT projections are recorded
Comparison of planning on X-ray images in different projections shows that the errors at unstandard AP and LAT projections are larger than that at standard AP and LAT projections, and the errors increase with the angle of real projection to standard AP and LAT projections in general
Summary
Precise positioning of femoral and tibial tunnel is the key to anterior cruciate ligament (ACL) reconstruction. Navigation systems for ACL reconstruction started in 2005 These navigation systems can be classified into three types: point cloud based, 3-D printing based, and intraoperative X-ray image based. (3) A computer-assisted navigation system based on X-ray[14] can improve the accuracy and reproducibility of the tunnel placement. ACL tunnels could be located accurately with ACL remnant preservation using intraoperative X-ray image-based method, individual differences are ignored,[17] which would make the ACL tunnel un-anatomical. The reconstruction tunnels can be planned anatomically with ACL remnant preserved and be paced accurately satisfying the clinical requirements. The surgery time of ACL reconstruction is 30–40 min, which is very close to the traditional arthroscopic ACL reconstruction
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