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Computer assisted arthroscopic anterior cruciate ligament reconstruction

  • Conference paper
CARS 2002 Computer Assisted Radiology and Surgery

Abstract

Rupture of the Anterior Cruciate Ligament (ACL) is a common problem, mainly in young and active adults. It may lead to premature degenerative arthritis of the knee joint. The current standard surgical procedure is the endoscopic reconstruction of the ACL using a central-third bone — patellar tendon — bone graft. Correct placement, especially the isome-try of the femoral and tibial insertion of the graft, is of primary importance for the stability of the reconstructed ligament. However, planning the correct insertion points and accurately executing the planned procedure is often difficult. In this paper we report on a fluoroscopic navigation system using intra-operative x-ray images to identify the correct position of the insertion points, and to guide the drilling of the tibial and femoral tunnel.

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References

  1. To, J. T., Howell, S. M., and Hull, M. L., “Contributions of femoral fixation methods to the stiffness of ACL replacements at implantation.”, Arthroscopy., 15(4): 379–387, 1999.

    Article  PubMed  CAS  Google Scholar 

  2. Butler, J. C., Branch, T. P., and Hutton, W. C., “Optimal graft fixation-the effect of gap size and screw size on bone plug fixation in ACL reconstruction.”, Arthroscopy, 10(5): 524–529,1994.

    Article  PubMed  CAS  Google Scholar 

  3. Boden, B., Migaud, H., Gougeon, F., Debroucker, M. J., and Duquennoy, A., “Effect of graft position on laxity after ACL reconstruction. Stress radiography in 90 knees 2 to 5 years after autograft.”, Acta Orthop.Belg., 62(1): 2–7, 1996.

    PubMed  CAS  Google Scholar 

  4. Bylski-Austrow, D. I., Grood, E. S., Hefzy, M. S., Holden, J. P., and Butler, D. L., “ACL replacements: a mechanical study of femoral attachment location, flexion angle at tensioning, and initial tension.”, J.OrthopRes, 8: 522–531, 1990.

    CAS  Google Scholar 

  5. Djian, P., Christel, P., Roger, B., and Witvoet, J., “Roentgenographic and magnetic resonance imaging of anterior cruciate reconstruction using a patellar tendon graft-correlations with physical findings.”, Knee.Surg.Sports Traumatol.Arthrose., 2(4): 207–213, 1994.

    Article  CAS  Google Scholar 

  6. Klos, T.-V. S., Harman, M. K., Devilee, R. J., Banks, S. A., and Cook, F. F., “Patellar tendon graft position after ACL reconstruction. Interobserver variability on lateral radiographs.”, Acta Orthop.Scand., 70(2): 180–184, 1999.

    Article  PubMed  CAS  Google Scholar 

  7. Klos, T.-V. S., Banks, A. Z., Lambregts, K-A. H., Banks, S. A., Cook, F. F., “Radiographic parameters for ACL reconstruction.”, Proceedings of CAR’96: Computer Assisted Radiology-10 th International Symposium, Ed.: Vannier, M. W., Inamura, K., and Farman, A. G., 832–836. Springer, Paris,France, 1996.

    Google Scholar 

  8. Collette, M., Mertens, H., Peters, M., and Chaput, A., “Radiological method for preoperative determination of isometric attachment points of an ACL graft.”, Knee.Surg.Sports Traumatol.Arthrose., 4(2): 75–83, 1996.

    Article  CAS  Google Scholar 

  9. Feller, J. A., Glisson, R. R., Seaber, A. V., Feagin, J. A. J., and Garrett, W. E. J., “Graft isometricity in unitunnel ACL reconstruction: analysis of influential factors using a radiographic model.”, Knee.Surg.Sports Traumatol.Arthrose., 1(3-4): 136–142, 1993.

    Article  CAS  Google Scholar 

  10. Lintner, D. M., Dewitt, S. E., and Moseley, J. B., “Radiographic evaluation of native ACL attachments and graft placement for reconstruction. A cadaveric study.”, Am.J.Sports Med, 24(1): 72–78,1996.

    Article  PubMed  CAS  Google Scholar 

  11. Khalfayan, E. E., Sharkey, P. F., Alexander, A. H., Bruckner, J. D., and Bynum, E. B., “The relationship between tunnel placement and clinical results after ACL reconstruction.”, Am.J.Sports Med., 24(3): 335–341, 1996.

    Article  PubMed  CAS  Google Scholar 

  12. Muneta, T., Yamamoto, H., Ishibashi, T., Asahina, S., Murakami, S., and Furuya, K., “The effects of tibial tunnel placement and roofplasty on reconstructed ACL knees.”, Arthroscopy., 11(1): 57–62, 1995.

    Article  PubMed  CAS  Google Scholar 

  13. Howell, S. M., “Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn ACL.”, Knee.Surg.Sports Traumat.Arthrose.,6(Suppl):S49–S55, 1998.

    Article  Google Scholar 

  14. Ikeda, H., Muneta, T., Niga, S., Hoshino, A., Asahina, S., and Yamamoto, H., “The long-term effects of tibial drill hole position on the outcome of ACL reconstruction.”, Arthroscopy., 15(3): 287–291, 1999.

    Article  PubMed  CAS  Google Scholar 

  15. Bernard, M., Hertel, P., Hornung, H., and Cierpinski, T., “Femoral insertion of the ACL. Radiographic quadrant method.”, Am.J.Knee.Surg., 10(1): 14–21, 1997.

    PubMed  CAS  Google Scholar 

  16. Cassisa, G., Nasi, M., Peretti, M., and Pappalardo, S., “X-ray evaluation of interferential femoral screw positioning in ACL reconstruction.”, Chir.Organi.Mov., 81(3): 257–261, 1996.

    PubMed  CAS  Google Scholar 

  17. Berg, E. E., “Parsons’ knob (tuberculum intercondylare tertium). A guide to tibial ACL insertion.”, Clin.Orthop.292: 229–231, 1993.

    PubMed  Google Scholar 

  18. Morgan, C. D., Kaiman, V. R., and Grawl, D. M., “Definitive landmarks for reproducible tibial tunnel placement in ACL reconstruction.”, Arthroscopy, 11(3): 275–288, 1995.

    Article  PubMed  CAS  Google Scholar 

  19. Milankov, M. and Miljkovic, N., “A new positioning device for precise femoral insertion of the ACL autograft”, Knee.Surg.Sports Traumatol.Arthrosc., 8(3): 149–153, 2000.

    Article  PubMed  CAS  Google Scholar 

  20. Klos, T.-V. S., Habets, R. J., Banks, A. Z., Banks, S. A., Devilee, R. J., and Cook, F. F., “Computer assistance in ACL reconstruction.”, Clin.Orthop.354: 65–69, 1998.

    Article  PubMed  Google Scholar 

  21. Klos, T.-V. S., Banks, S. A., Cook, F. F., Harman, M. K., Banks, A. Z., Ed, b. S., Morgan, K., Sieburg, H. B., Mattheus, R., and Christensen, J. P. “Interactive fluoroscopic controlled ACL.” InteractiveTechnology and the New Paradigm for Healthcare.Medicine meets Virtual Reality III Proceedings): 173-174. San Diego, CA, USA, 1995

    Google Scholar 

  22. Koppe, R., Klotz, E., Op de Beek, J., and Aerts, H. “3D vessel reconstruction based on rotational angiography.”, Proceedings CAR’95, H.U. Lemke, K. Inamura, C.C. Jaffe, M.W. Vannier (editors)): 101–107, Berlin, 1995.

    Google Scholar 

  23. Grass, M., Koppe, R., Klotz, E., Proksa, R., Kuhn, M. H., Aerts, H., Op, d. B., and Kemkers, R., “Three-dimensional reconstruction of high contrast objects using C-arm image intensifier projection data”, Comput.Med.Imaging Graph., 23(6): 311–321, 1999.

    Article  PubMed  CAS  Google Scholar 

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© 2002 Springer-Verlag Berlin Heidelberg

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Sabczynski, J. et al. (2002). Computer assisted arthroscopic anterior cruciate ligament reconstruction. In: Lemke, H.U., Inamura, K., Doi, K., Vannier, M.W., Farman, A.G., Reiber, J.H.C. (eds) CARS 2002 Computer Assisted Radiology and Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56168-9_43

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  • DOI: https://doi.org/10.1007/978-3-642-56168-9_43

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-62844-3

  • Online ISBN: 978-3-642-56168-9

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