Paper #67 The use of CAOS (Computer Assisted Orthopaedic Surgery System) to evaluate the intra- and the inter-surgeon reliability in tunnel placement for ACL reconstruction

Abstract

Objectives1) To evaluate surgeon reliability in tunnel placement for ACL reconstruction with the use of the CAOS system; and 2) to evaluate the efficiency of CAOS to assist the surgeon with tunnel position.BackgroundThe success of anterior cruciate ligament reconstruction depends upon the correct placement of tibial and femoral tunnels. Failures are usually due to mal-position of the tibial and / or femoral tunnels.Design/methodsA standard arthroscopic approach was performed in three cadaver knees and 14 surgeons (5 orthopaedic fellows, 5 general orthopaedic surgeons and 4 knee surgeons) were asked to place femoral and tibial tunnels. They, then, placed femoral and tibial tunnels with the use of the CAOS system. All the points were recorded and compared to tibial and femoral reference points (from the ideal graft) using a data processing software on Matlab.ResultsIntra-surgeon reproducibility was 1.1 mm on the femur and 1.4 mm on the tibia. The mean variability was 3.1 (1.4) mm and 3.4 (0.8) mm. The inter-surgeon variability was 6.3 (3) mm on the femur and 5.6 (1.6) mm on the tibia.ConclusionsIntra-surgeon reproducibility is good, but variability is high which is a concern as regards clinical consequences. The inter-surgeon variability is great and depends upon experience. The CAOS system allows a more precise placement on the femur, and on the tibia only in the medio-lateral axis. Objectives1) To evaluate surgeon reliability in tunnel placement for ACL reconstruction with the use of the CAOS system; and 2) to evaluate the efficiency of CAOS to assist the surgeon with tunnel position. 1) To evaluate surgeon reliability in tunnel placement for ACL reconstruction with the use of the CAOS system; and 2) to evaluate the efficiency of CAOS to assist the surgeon with tunnel position. BackgroundThe success of anterior cruciate ligament reconstruction depends upon the correct placement of tibial and femoral tunnels. Failures are usually due to mal-position of the tibial and / or femoral tunnels. The success of anterior cruciate ligament reconstruction depends upon the correct placement of tibial and femoral tunnels. Failures are usually due to mal-position of the tibial and / or femoral tunnels. Design/methodsA standard arthroscopic approach was performed in three cadaver knees and 14 surgeons (5 orthopaedic fellows, 5 general orthopaedic surgeons and 4 knee surgeons) were asked to place femoral and tibial tunnels. They, then, placed femoral and tibial tunnels with the use of the CAOS system. All the points were recorded and compared to tibial and femoral reference points (from the ideal graft) using a data processing software on Matlab. A standard arthroscopic approach was performed in three cadaver knees and 14 surgeons (5 orthopaedic fellows, 5 general orthopaedic surgeons and 4 knee surgeons) were asked to place femoral and tibial tunnels. They, then, placed femoral and tibial tunnels with the use of the CAOS system. All the points were recorded and compared to tibial and femoral reference points (from the ideal graft) using a data processing software on Matlab. ResultsIntra-surgeon reproducibility was 1.1 mm on the femur and 1.4 mm on the tibia. The mean variability was 3.1 (1.4) mm and 3.4 (0.8) mm. The inter-surgeon variability was 6.3 (3) mm on the femur and 5.6 (1.6) mm on the tibia. Intra-surgeon reproducibility was 1.1 mm on the femur and 1.4 mm on the tibia. The mean variability was 3.1 (1.4) mm and 3.4 (0.8) mm. The inter-surgeon variability was 6.3 (3) mm on the femur and 5.6 (1.6) mm on the tibia. ConclusionsIntra-surgeon reproducibility is good, but variability is high which is a concern as regards clinical consequences. The inter-surgeon variability is great and depends upon experience. The CAOS system allows a more precise placement on the femur, and on the tibia only in the medio-lateral axis. Intra-surgeon reproducibility is good, but variability is high which is a concern as regards clinical consequences. The inter-surgeon variability is great and depends upon experience. The CAOS system allows a more precise placement on the femur, and on the tibia only in the medio-lateral axis.