Outcomes after conventional versus computer-navigated anterior cruciate ligament reconstruction

Abstract

Purpose: The purpose of this prospective randomized study was to assess biomechanical, radiographic, and functional results after single-bundle anterior cruciate ligament (ACL) reconstruction by use of a navigation system.

Methods: ACL reconstruction was performed by use of the OrthoPilot navigation system (B. Braun-Aesculap, Tuttlingen, Germany) in 40 patients (group 1); and in another 40 patients, surgery was done by the standard manual targeting technique (group 2). The anterior laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Femoral and tibial tunnel position was evaluated radiologically according to the method described by Bernard and Hertel and by Harner et al., respectively. The questionnaire-based Lysholm and International Knee Documentation Committee scales were included to compare the functional state in both groups.

Results: The knees in group 1 were as stable as those in group 2 during the arthrometer testing, with a lower value of dispersion. The postoperative Lysholm and International Knee Documentation Committee scores had the same value in both groups. Statistical differences existed with regard to anterior-posterior femoral tunnel placement when the navigated and standard techniques were compared; in the navigated group, more exact results were found. No significant complications were observed.

Conclusions: The only difference that we found between the navigated and standard groups was in radiographic tunnel position measurement. The computer-assisted navigation technique in our study resulted in more accurate tunnel placement in the femur (but not the tibia) than the traditional arthroscopic technique. However, the performed standard radiographic measurements are of limited precision in principle. Functional scales and stability tests gave similar results in both groups.

Level of evidence: Level I, therapeutic study.