The anterior cruciate ligament tear is a common medical condition that is treated using arthroscopy by pulling a tissue graft through a tunnel opened with a drill. The correct anatomical position and orientation of this tunnel are crucial for knee stability, and drilling an adequate bone tunnel is the most technically challenging part of the procedure. This paper presents the first guidance system based solely on intra-operative video for guiding the drilling of the tunnel.
Our solution uses small, easily recognizable visual markers that are attached to the bone and tools for estimating their relative pose. A recent registration algorithm is employed for aligning a pre-operative image of the patient’s anatomy with a set of contours reconstructed by touching the bone surface with an instrumented tool.
Experimental validation using ex-vivo data shows that the method enables the accurate registration of the pre-operative model with the bone, providing useful information for guiding the surgeon during the medical procedure. Experiments also demonstrate that the guided drilling of the tunnel leads to errors as low as 2.5 mm in the footprint and \(1.8^\circ \) in orientation, which compares favourably to other works in the field.
The high accuracy and short time overhead evinced by the experimental validation combined with no additional incisions or capital equipment make this video-based computer-aided arthroscopy solution an appealing alternative to the existing approaches.
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Barrett DS (1991) Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br 73(5):833–837
Belhaoua A, Kornmann A, Radoux J (2014) Accuracy analysis of an augmented reality system. In: ICSP
Besl PJ, McKay ND (1992) A method for registration of 3-d shapes. IEEE Trans Pattern Anal Mach Intell 14(2):239–256
Brown CH, Spalding T, Robb C (2013) Medial portal technique for single-bundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop 37(2):253–269
Cho WJ, Kim JM, Kim DE, Lee JG, Park JW, Han YH, Seo HG (2018) Accuracy of the femoral tunnel position in robot-assisted anterior cruciate ligament reconstruction using a magnetic resonance imaging-based navigation system: a preliminary report. Int J Med Robot Comput Assist Surg 14(5):e1933
Dessenne V, Lavallée S, Julliard R, Orti R, Martelli S, Cinquin P (1995) Computer-assisted knee anterior cruciate ligament reconstruction: first clinical tests. J Image Guided Surg 1(1):59–64
Forsythe B, Kopf S, Wong AK, Martins CAQ, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92(6):1418–1426
Hart A, Sivakumaran T, Burman M, Powell T, Martineau PA (2018) A prospective evaluation of femoral tunnel placement for anatomic anterior cruciate ligament reconstruction using 3-dimensional magnetic resonance imaging. AM J Sports Med 46(1):192–199
Jannin P, Grova C, Calvin R, Maurer J (2006) Model for defining and reporting reference-based validation protocols in medical image processing. Int J CARS 1(2):63–73
Lavest JM, Rives G, Lapreste JT (2003) Dry camera calibration for underwater applications. MVA 13(5–6):245–253
Lourenço M, Barreto JP, Fonseca F, Ferreira H, Duarte RM, Correia-Pinto J (2014) Continuous zoom calibration by tracking salient points in endoscopic video. In: MICCAI
Mahmoud N, Cirauqui I, Hostettler A, Doignon C, Soler L, Marescaux J, Montiel JMM (2016) Orbslam-based endoscope tracking and 3d reconstruction. In: CARE@MICCAI
Maier-Hein L, Mountney P, Bartoli A, Elhawary H, Elson D, Groch A, Kolb A, Rodrigues M, Sorger J, Speidel S, Stoyanov D (2013) Optical techniques for 3d surface reconstruction in computer-assisted laparoscopic surgery. Med Image Anal 17(8):974–996
Margier J, Tchouda SD, Banihachemi JJ, Bosson JL, Plaweski S (2014) Computer-assisted navigation in acl reconstruction is attractive but not yet cost efficient. Knee Surg Sports Traumatol Arthrosc 23(4):1026–1034
Mei C, Benhimane S, Malis E, Rives P (2008) Efficient homography-based tracking and 3-d reconstruction for single-viewpoint sensors. IEEE Trans Robot 24(6):1352–1364
Melo R, Barreto JP, Falcao G (2012) A new solution for camera calibration and real-time image distortion correction in medical endoscopy-initial technical evaluation. IEEE Trans Biomed Eng 59(3):634–644
Mur-Artal R, Montiel JMM, Tardós JD (2015) ORB-SLAM: a versatile and accurate monocular SLAM system. IEEE Trans Robot 31(5):1147–1163. https://doi.org/10.1109/TRO.2015.2463671
Picard F, DiGioia AM, Moody J, Martinek V, Fu F, Rytel M, Nikou C, LaBarca RS, Jaramaz B (2001) Accuracy in tunnel placement for acl reconstruction. comparison of traditional arthroscopic and computer-assisted navigation techniques. Comput Aided Surg: Off J Int Soc Comput Aided Surg 6(5):279–89
Plaweski S, Pearle A, Granchi C, Julliard R (2007) Praxim ACL navigation system using bone morphing. In: Navigation and MIS in orthopedic surgery
Plaweski S, Schlatterer B, Saragaglia D, Computer Assisted Orthopedic Surgery - France (CAOS - France) (2015) The role of computer assisted navigation in revision surgery for failed anterior cruciate ligament reconstruction of the knee: a continuous series of 52 cases. Orthop Traumatol Surg Res 101(6 Suppl):S227–S231
Raposo C, Barreto JP (2018) 3d registration of curves and surfaces using local differential information. In: CVPR
Raposo C, Sousa C, Ribeiro LL, Melo R, Barreto JP, Oliveira J, Marques P, Fonseca F (2018) Video-based computer aided arthroscopy for patient specific reconstruction of the anterior cruciate ligament. In: MICCAI
Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW (2015) Failure of anterior cruciate ligament reconstruction. In: ABJS
Treuting R (2000) Minimally invasive orthopedic surgery: arthroscopy. Ochsner J 2(3):158–163
Funding was provided by Fundação para a Ciência e a Tecnologia (Grant No. PTDC/EEIAUT/3024/2014) and Horizon 2020 (Grant No. 766850).
Conflict of interest
The authors declare that they have no conflict of interest.
All studies involving post-mortem subjects followed the procedures for informed consent that are described in the Declaration of Helsinki.
Informed consent was obtained from all individual participants included in the study.
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The authors thank the Portuguese Science Foundation and COMPETE2020 program for generous funding through project VisArthro (ref.: PTDC/EEIAUT/3024/2014). This paper was also funded by the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 766850.
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Raposo, C., Barreto, J.P., Sousa, C. et al. Video-based computer navigation in knee arthroscopy for patient-specific ACL reconstruction. Int J CARS 14, 1529–1539 (2019) doi:10.1007/s11548-019-02021-0
- Computer guidance
- Visual tracking
- 3D registration