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Two-dimensional fluoroscopic navigation in posterior cruciate ligament reconstruction: a preclinical cadaver study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objectives

To assess the feasibility and accuracy of frameless stereotactic two-dimensional fluoroscopy-assisted guide pin (GP) placement in posterior cruciate ligament (PCL) reconstruction in human cadavers.

Materials and methods

A total of 13 pins were placed in 7 cadaver specimens, using a fluoroscopic-based navigation technique. The knees were fixed noninvasively on a carbon baseplate. Interventions were planned on intraoperatively acquired perpendicular fluoroscopic images. A stereotactic aiming device was mounted to the carbon baseplate and adjusted according to the planned trajectories. GPs were advanced through the aiming device to the precalculated depth. GP positions were verified by image fusion of the fluoroscopic planning and control data, respectively. Measurements were scored on three occasions by one independent observer. In order to assess interobserver reliability, measurements were scored by two further independent observers on one occasion.

Results

The femoral cohort included seven GP placements in seven cadavers. Mean GP placement accuracy according to plan was 1.3 mm (SD 0.9 mm, range 0.3–3.8 mm) at the target point. The recorded femoral angular misalignment of GPs was 1.1° (SD 0.9°, range 0.2°–3.3°). The tibial cohort included six GP placements in six cadavers. Mean GP placement accuracy according to the plan was 1.8 mm (SD 2.1 mm, range 0.3–9.5 mm). The recorded tibial angular misalignment of GPs was 1.4° (SD 1.1°, range 0.1°–5°). Navigated GP implantation, as planned, was optimal in six out of seven cases in the femoral cohort and in four out of six cases in the tibial cohort.

Conclusion

Our preliminary cadaver study suggests that the use of fluoroscopic-based navigation combined with a stereotactic targeting device may be a helpful tool to improve PCL reconstruction. In addition, this method may also be used for other minimal invasive skeletal interventions.

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Conflict of interest statement

No financial support of this project has occurred. Prof. Bale is a co-inventor of the Vertek targeting device and a co-shareholder in its financial returns.

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Authors and Affiliations

  1. Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria

    Ralf E. Rosenberger, Cornelia Kneisl, Dietmar Krappinger & Rene Attal

  2. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Reto J. Bale & Martin Knoflach

Authors
  1. Ralf E. Rosenberger
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  2. Reto J. Bale
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  3. Cornelia Kneisl
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  4. Dietmar Krappinger
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  6. Rene Attal
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Corresponding author

Correspondence to Ralf E. Rosenberger.

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Rosenberger, R.E., Bale, R.J., Kneisl, C. et al. Two-dimensional fluoroscopic navigation in posterior cruciate ligament reconstruction: a preclinical cadaver study. Arch Orthop Trauma Surg 130, 971–976 (2010). https://doi.org/10.1007/s00402-009-1037-z

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  • DOI: https://doi.org/10.1007/s00402-009-1037-z

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