Analysis of anatomic positioning in computer-assisted and conventional anterior cruciate ligament reconstruction

Abstract

Anterior cruciate ligament (ACL) reconstruction should be anatomic while achieving favorable anisometric behavior to avoid impingement with the femoral notch. Computerization enables these biomechanical conditions to be optimally fulfilled; but what of anatomic positioning? The present study compared the positioning of tibial and femoral tunnels, drilled using either a conventional ACL guide or a navigation system, using the anatomic foot-print areas of the native ACL. This cadaver study used computerized recording to compare tibial and femoral ACL attachment areas to the positioning of tunnels created either conventionally or under computer-guided navigation. Computer guidance enabled the tibial and femoral tunnels to be systematically positioned within the anatomic area and, as regards the tibial area, within the anterior third near to the medial tibial spine, without femoral notch impingement. Anisometry was in all cases favorable, at a mean 3.3 ± 0.7 mm; using a conventional guide, anisometry was favorable in only 50% of cases, at a mean 5.4 ± 1.2 mm. Computer-guided navigation ensured implant positioning within the so-called anatomometric area of the native ACL attachment, avoiding impingement with the femoral notch. Level 2.