Abstract
Reconstruction surgery of torn ligaments typically requires precise and anatomically correct fixation of the graft substitute on the bone surface. Several planning methodologies have been proposed that aim at standardizing the interventional procedure by localizing drill sites or defining the drill tunnel orientation with the help of anatomical landmarks. However, the practical implementation is limited by the often complex and time-consuming nature of the planning steps. For this reason, we propose an automatic solution for safe guide pin path planning based on bone contour extraction, axis detection, anatomical landmark detection, and geometrical construction. We evaluate our approach for the task of double-bundle posterior cruciate ligament reconstruction surgery on the lateral tibia using 38 clinical X-ray images. Our method achieves a median path angulation error of \(0.37^{\circ }\) and a median localization error of 0.96 mm for the ligament attachment center.
The authors gratefully acknowledge funding of the Erlangen Graduate School in Advanced Optical Technologies (SAOT) by the Bavarian State Ministry for Science and Art.
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References
Anderson, C.J., Ziegler, C.G., Wijdicks, C.A., Engebretsen, L., LaPrade, R.F.: Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cruciate ligament. J. Bone Joint Surg. Am. 94(21), 1936–1945 (2012). https://doi.org/10.2106/JBJS.K.01710
Bertollo, N., Walsh, W.R.: Drilling of bone: Practicality, limitations and complications associated with surgical drill-bits. In: Klika, V. (ed.) Biomechanics in Applications, Chap. 3. IntechOpen, Rijeka (2011). https://doi.org/10.5772/20931
Caversaccio, M., et al.: Robotic cochlear implantation: surgical procedure and first clinical experience. Acta oto-laryngologica 137(4), 447–454 (2017). https://doi.org/10.1080/00016489.2017.1278573
Chahla, J., Nitri, M., Civitarese, D., Dean, C.S., Moulton, S.G., LaPrade, R.F.: Anatomic double-bundle posterior cruciate ligament reconstruction. Arthroscopy Tech. 5(1), e149-56 (2016). https://doi.org/10.1016/j.eats.2015.10.014
Ewerbeck, V., et al. (eds.): Standardverfahren in der operativen Orthopädie und Unfallchirurgie, 4th edn. Thieme, Stuttgart (2014)
Jackson, D.W., Proctor, C.S., Simon, T.M.: Arthroscopic assisted PCL reconstruction: a technical note on potential neurovascular injury related to drill bit configuration. Arthroscopy J. Arthroscopic Related Surg. 9(2), 224–227 (1993). https://doi.org/10.1016/s0749-8063(05)80381-0
Johannsen, A.M., Anderson, C.J., Wijdicks, C.A., Engebretsen, L., LaPrade, R.F.: Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions. Am. J. Sports Med. 41(1), 35–42 (2013). https://doi.org/10.1177/0363546512465072
Kordon, F., Maier, A., Swartman, B., Privalov, M., El Barbari, J.S., Kunze, H.: Contour-based bone axis detection for X-Ray guided surgery on the knee. In: Martel, A.L., et al. (eds.) MICCAI 2020. LNCS, vol. 12266, pp. 671–680. Springer, Cham (2020). https://doi.org/10.1007/978-3-030-59725-2_65
Kordon, F., et al.: Multi-task localization and segmentation for X-Ray guided planning in knee surgery. In: Shen, D., et al. (eds.) MICCAI 2019. LNCS, vol. 11769, pp. 622–630. Springer, Cham (2019). https://doi.org/10.1007/978-3-030-32226-7_69
LaPrade, R.F., et al.: Double-bundle posterior cruciate ligament reconstruction in 100 patients at a mean 3 years’ follow-up: outcomes were comparable to anterior cruciate ligament reconstructions. Am. J. Sports Med. 46(8), 1809–1818 (2018). https://doi.org/10.1177/0363546517750855
Longo, U.G., et al.: Epidemiology of posterior cruciate ligament reconstructions in Italy: a 15-year study. J. Clin. Med. 10(3), 499 (2021). https://doi.org/10.3390/jcm10030499
Montgomery, S.R., Johnson, J.S., McAllister, D.R., Petrigliano, F.A.: Surgical management of PCL injuries: indications, techniques, and outcomes. Curr. Rev. Musculoskelet. Med. 6(2), 115–123 (2013). https://doi.org/10.1007/s12178-013-9162-2
Newell, A., Yang, K., Deng, J.: Stacked hourglass networks for human pose estimation. In: Leibe, B., Matas, J., Sebe, N., Welling, M. (eds.) ECCV 2016. LNCS, vol. 9912, pp. 483–499. Springer, Cham (2016). https://doi.org/10.1007/978-3-319-46484-8_29
Nicodeme, J.D., Löcherbach, C., Jolles, B.M.: Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review. Knee Surg. Sports Traumatol. Arthroscopy 22(7), 1556–1562 (2014). https://doi.org/10.1007/s00167-013-2563-3
Paszke, A., et al.: PyTorch: an imperative style, high-performance deep learning library. In: Wallach, H., Larochelle, H., Beygelzimer, A., Alché-Buc, F.d., Fox, E., Garnett, R. (eds.) Advances in Neural Information Processing System, vol. 32, pp. 8026–8037. Curran Associates, Inc. (2019)
Raposo, C., et al.: Video-based computer navigation in knee arthroscopy for patient-specific ACL reconstruction. Int. J. Comput. Assist. Radiol. Surg. 14(9), 1529–1539 (2019). https://doi.org/10.1007/s11548-019-02021-0
Rossini, M., Valentini, S., Portaccio, I., Campolo, D., Fasano, A., Accoto, D.: Localization of drilling tool position through bone tissue identification during surgical drilling. Mechatronics 67, 102342 (2020). https://doi.org/10.1016/j.mechatronics.2020.102342
Schöttle, P.B., Schmeling, A., Rosenstiel, N., Weiler, A.: Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am. J. Sports Med. 35(5), 801–804 (2007). https://doi.org/10.1177/0363546506296415
Sederberg, T.W., Nishita, T.: Curve intersection using Bézier clipping. Comput.-Aided Des. 22(9), 538–549 (1990). https://doi.org/10.1016/0010-4485(90)90039-F
Spiridonov, S.I., Slinkard, N.J., LaPrade, R.F.: Isolated and combined grade-III posterior cruciate ligament tears treated with double-bundle reconstruction with use of endoscopically placed femoral tunnels and grafts: operative technique and clinical outcomes. J. Bone Joint Surg. Am. 93(19), 1773–1780 (2011). https://doi.org/10.2106/JBJS.J.01638
Warton, D.I., Wright, I.J., Falster, D.S., Westoby, M.: Bivariate line-fitting methods for allometry. Biol. Rev. Cambridge Philos. Soc. 81(2), 259–291 (2006). https://doi.org/10.1017/S1464793106007007
Weimann, A., Wolfert, A., Zantop, T., Eggers, A.K., Raschke, M., Petersen, W.: Reducing the “killer turn” in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture. Arthroscopy J. Arthroscopic Related Surg. 23(10), 1104–1111 (2007). https://doi.org/10.1016/j.arthro.2007.04.014
Yang, B., Hu, L., Guo, N., Wang, Y., Liu, H., Han, Z.: Anterior cruciate ligament reconstruction surgery navigation and robotic positioning system under X-rays. In: 2018 IEEE International Conference on Robotics and Biomimetics (ROBIO), pp. 156–163 (2018)
Yao, J., et al.: Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction. Int. Orthopaedics 38(5), 973–981 (2014). https://doi.org/10.1007/s00264-014-2290-5
Zhu, M., et al.: Tibial tunnel placement in anatomic anterior cruciate ligament reconstruction: a comparison study of outcomes between patient-specific drill template versus conventional arthroscopic techniques. Archiv. Orthopaedic Trauma Surg. 138(4), 515–525 (2018). https://doi.org/10.1007/s00402-018-2880-6
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Kordon, F., Maier, A., Swartman, B., Privalov, M., El Barbari, J.S., Kunze, H. (2021). Automatic Path Planning for Safe Guide Pin Insertion in PCL Reconstruction Surgery. In: de Bruijne, M., et al. Medical Image Computing and Computer Assisted Intervention – MICCAI 2021. MICCAI 2021. Lecture Notes in Computer Science(), vol 12904. Springer, Cham. https://doi.org/10.1007/978-3-030-87202-1_54
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