Abstract
Among failures due to surgical techniques, the most common technical error is poor tunnel placement [6, 13]. Anisometric graft positioning can cause graft stretch and poor control of knee rotational or translational stability. For example, anterior femoral tunnel placement produces strain in flexion and laxity in extension while posterior femoral tunnel placement produces strain in extension and laxity in flexion and risks back wall »blow out«. Anterior tibial tunnel placement results in strain in flexion and possible impingement in extension. Posterior tibial tunnel placement places strain on the graft in extension and possible PCL impingement. Medial or lateral tibial tunnel positioning can cause impingement conflicts with the PCL and femoral condyles. Current surgical techniques rely on anatomic criteria, intra-operative fluoroscopy, and alignment jigs to create an isometric, non-impinging, and appropriately positioned graft. However, arthroscopic landmarks may be variable and inaccurate, fluoroscopic monitoring is cumbersome, and conventional transtibial approaches jigs such as the over-the-top guide can affect the femoral and tibial positioning (femoral tunnel tends to be anterior and vertical and tibial tunnel tends to be posterior) [5]. Surgical navigation offers an additional means of supervising tunnel positioning. In addition to anatomic criteria, quantitative isometric and impingement criteria can be used to plan tunnel positioning. This provides the surgeon with increased control in choosing tunnel position to optimize graft placement for the individual knee anatomy. This chapter represents a summary of some recent research and clinical experience carried out at our institutes with the PRAXIM ACL navigation system. Below, a brief history and detailed description of the system is provided. Three recent studies related to the technical and clinical evaluation of the system, as well as to its use in revision procedures, are then presented, followed by a brief discussion.
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