Mauch Frieder, Apic Goran, Becker Ulrich, Bauer Gerhard
Sportsclinic Stuttgart, Clinic for Orthopedic Surgery and Sportstraumatology, Taubenheimstrasse 8, Stuttgart, Germany.
Am J Sports Med. 2007 Nov;35(11):1824-32. doi: 10.1177/0363546507305678. Epub 2007 Sep 18.
Next to graft fixation, correct positioning of the tibial and femoral tunnel is a deciding factor for the clinical result of anterior cruciate ligament reconstruction surgery. Computer-assisted navigation has been proposed as a method to improve tunnel positioning.
To examine the differences in tibial tunnel placement between cruciate ligament operations using manual and computer-assisted navigation.
Randomized controlled trial; Level of evidence, 1.
Between December 2003 and April 2004, 53 athletes underwent anterior cruciate ligament reconstruction surgery with arthroscopic press-fit technique. The first group (group N; 24 athletes) were operated on with the aid of a navigation system (OrthoPilot, Aesculap AG & Co. KG, Braun), and the second group (group M; 29 athletes) were "manually" operated on. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel four days postoperatively. In the measurements, the anterior and posterior boundaries of the tibial tunnel, as well as the center of the tibial tunnel in relation to the maximum tibia anteroposterior diameter were evaluated (indicated in percent). An analysis of the tibial tunnel position proportional to the slope of the intercondylar roof was done to determine intercondylar impingement (method according to Howell). The centers of the tibial tunnels were compared with the "optimal" position noted in previous studies. The standard deviation was determined for both groups to determine the variance of placement.
The anterior tibial tunnel border was 19.4 mm in group M (29.7%) and 21.2 mm in group N (32.2%) (P = .18). The center of the tibial tunnel was located at 24.6 mm in group M (35.6%) and at 26.6 mm in group N (40.3%) (P = .19). In group M, the posterior tibial tunnel position was located at 30.2 mm (46.2%), and in group N at 32.2 mm (49.1%) (P = .21). When comparing the centers of the tibial tunnels with the optimal 44% found in previous studies, the value for group M (37.6%) varied significantly, while group N (40.5%) did not. However, there was no significant difference in the range variance for either group; the standard deviation was 6.9% (4.3 mm) for group M and 5.9% (3.5 mm) for group N. One athlete showed moderate impingement in group N, and two athletes in group M.
Assisted navigation offers good support for correct placement of the tibial tunnel, although experienced surgeons can achieve essentially the same positioning as surgeons using computer-assisted navigation. Whether it is advisable to implement this procedure in daily surgical routine should be decided based on clinical results.
除移植物固定外，胫骨和股骨隧道的正确定位是前交叉韧带重建手术临床效果的决定性因素。计算机辅助导航已被提议作为一种改善隧道定位的方法。
研究使用手动和计算机辅助导航进行交叉韧带手术时胫骨隧道放置的差异。
随机对照试验；证据等级，1级。
2003年12月至2004年4月期间，53名运动员接受了关节镜加压配合技术的前交叉韧带重建手术。第一组（N组；24名运动员）在导航系统（OrthoPilot，蛇牌股份公司，布劳恩）辅助下进行手术，第二组（M组；29名运动员）进行“手动”手术。术后4天使用膝关节最大伸展位的侧位X线片确定胫骨隧道的准确位置。在测量中，评估胫骨隧道的前后边界以及胫骨隧道中心相对于胫骨最大前后径的位置（以百分比表示）。对与髁间顶斜率成比例的胫骨隧道位置进行分析以确定髁间撞击（根据豪厄尔的方法）。将胫骨隧道的中心与先前研究中记录的“最佳”位置进行比较。确定两组的标准差以确定放置的差异。
M组胫骨隧道前边界为19.4 mm（29.7%），N组为21.2 mm（32.2%）（P = 0.18）。M组胫骨隧道中心位于24.6 mm（35.6%），N组位于26.6 mm（40.3%）（P = 0.19）。M组胫骨隧道后位置位于30.
