Zaffagnini S, Urrizola F, Signorelli C, Grassi A, Di Sarsina T Roberti, Lucidi G A, Marcheggiani Muccioli G M, Bonanzinga T, Marcacci M
Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, BO, Italy.
Dipartimento di Scienze Biomediche e Neuromotorie - DIBINEM, Università di Bologna, Bologna, BO, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3396-3409. doi: 10.1007/s00167-016-4356-y. Epub 2016 Oct 15.
The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years.
A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery.
One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined.
Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel placement; (2) improvement in knowledge of the kinematic behaviour of ACL and other structures; (3) comparison of effectiveness of different surgical techniques in controlling laxities; (4) navigation system performance to improve the outcomes of ACL reconstruction and cost-effectiveness.
IV.
本综述旨在分析关于导航系统在多年来前交叉韧带（ACL）重建手术中应用的现有文献，突显其发展历程。
在PubMed和Cochrane图书馆数据库中对索引科学论文进行检索。检索于2015年12月进行，无出版年份限制。仅考虑英文撰写且与术语ACL、导航、计算机辅助骨科手术（CAOS）和计算机辅助手术（CAS）相关的论文。两名评审员独立筛选，仅选择那些至少介绍了导航系统在ACL重建手术中应用的手稿。
最终从394篇文章中选出146篇。在此分析中，能够回顾导航系统在ACL手术中的主要用途，包括初次和翻修手术中的隧道定位以及不同手术操作前后膝关节松弛度的运动学评估。在早期，直至2006年，导航系统主要用于改善隧道定位，但自过去十年以来，该工具主要用于运动学评估。使用导航手术观察到隧道放置的准确性有所提高，特别是在股骨方面，146篇文章中有42篇使用导航来指导隧道定位。在随后的几年中，146篇文章中有82篇使用导航系统评估术中膝关节运动学。特别是，强调了控制旋转松弛以获得更好手术效果的重要性。
已描述了多种应用，尽管导航系统有其贡献、潜在用途和理论优势，但其临床益处仍存在争议。本文总结了在ACL重建中使用导航系统的最相关研究。特别是，分析确定了导航系统在ACL重建手术中的四个主要应用：（1）隧道放置的技术辅助；（2）提高对ACL和其他结构运动学行为的认识；（3）比较不同手术技术在控制松弛方面的有效性；（4）导航系统在改善ACL重建结果和成本效益方面的性能。
IV级。
