Department of Orthopedic Surgery, Joint Surgery Centre, Takatsuki General Hospital, 1-3-13 Kosobe-cho, Takatsuki, Osaka, 569-1192, Japan.
Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1503-10. doi: 10.1007/s00167-011-1726-3. Epub 2011 Oct 22.
The first purpose of this study was to examine whether fluoroscopic-based navigation system contributes to the accuracy and reproducibility of the bone tunnel placements in single-bundle anterior cruciate ligament (ACL) reconstruction. The second purpose was to investigate the application of the navigation system for double-bundle ACL reconstruction.
A hospital-based case-control study was conducted, including a consecutive series of 55 patients. In 37 patients who received single-bundle ACL reconstruction, surgeries were performed with this system for 19 knees (group 1) and without this system for 18 knees (group 2). The positioning of the femoral and tibial tunnels was evaluated by plain sagittal radiographs. In 18 patients who received double-bundle ACL reconstruction using the navigation system (group 3), the bone tunnel positions were assessed by three-dimensional computed tomography (3D-CT). Clinical assessment of all patients was followed with the use of Lysholm Knees Score and IKDC.
Taking 0% as the anterior and 100% as the posterior extent, the femoral tunnels were 74.9 ± 3.0% in group 1 and 71.5 ± 5.8% in group 2 along Blumensaat's line, and the tibial tunnels were 42.3 ± 1.4% in group 1 and 42.5 ± 4.6% in group 2 along the tibia plateau. The bone tunnel positions in group 1 were located significantly closer to the position planned preoperatively and varied less in both femur and tibial side, compared with those without navigation (group 2). (Femur: P < 0.05, Tibia: P < 0.001) 3D-CT evaluation of double-bundle ACL reconstruction (group 3) also demonstrated that the bone tunnel positions of both anteromedial (AM) and posterolateral (PL) were placed as we expected.
The fluoroscopic-based navigation system contributed to the more reproducible placement of the bone tunnel during single-bundle ACL reconstruction compared with conventional technique. Additionally, this device was also useful for double-bundle ACL reconstruction.
Case-control study, Therapeutic study, Level III.
本研究的首要目的是检验基于透视的导航系统是否有助于提高单束前交叉韧带（ACL）重建中骨隧道定位的准确性和可重复性。其次，探讨该导航系统在双束 ACL 重建中的应用。
本研究为医院病例对照研究，纳入了 55 例连续患者。37 例接受单束 ACL 重建的患者中，19 膝采用该系统（1 组），18 膝未采用该系统（2 组）。通过标准矢状位 X 线评估股骨和胫骨隧道的定位。18 例接受双束 ACL 重建的患者采用导航系统（3 组），通过三维 CT（3D-CT）评估骨隧道位置。所有患者均采用 Lysholm 膝关节评分和 IKDC 进行临床评估。
以 0%为前界，100%为后界，1 组股骨隧道在 Blumensaat 线的位置为 74.9±3.0%，2 组为 71.5±5.8%；胫骨隧道在胫骨平台的位置 1 组为 42.3±1.4%，2 组为 42.5±4.6%。与未导航组（2 组）相比，1 组的骨隧道位置更接近术前计划位置，股骨和胫骨侧的变化更小。（股骨：P<0.05，胫骨：P<0.001）。对双束 ACL 重建的 3D-CT 评估（3 组）也表明，前内束（AM）和后外束（PL）的骨隧道位置均按预期放置。
与传统技术相比，基于透视的导航系统有助于提高单束 ACL 重建中骨隧道的可重复性。此外，该设备还可用于双束 ACL 重建。
病例对照研究，治疗性研究，III 级。
