Comparative Study on Anterior Cruciate Ligament Reconstruction: Determination of Isometric Points with and Without Navigation

Abstract

OBJECTIVES:To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot) and using traditional instruments.METHODS:The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot). An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1) posterior cruciate ligament, 2) anterior horn of the lateral meniscus and 3) medial tibial spine; 4) distance from the femoral tunnel center to the posterior femoral cortex; 5) femoral tunnel coronal angle; and 6) variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion.RESULTS:The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry) compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions.DISCUSSION:The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning.CONCLUSION:No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

“…Precise isometric point positioning has already been determined to be essential in ACL reconstruction ( 24 ). Camanho ( 25 ) believes that the concept of isometry could improve the principles of reconstruction of the posterolateral corner of the knee.…”

[ARTIGO RETRATADO] Revisão dos artigos sobre ortopedia recentemente publicados na imprensa científica brasileira

“…Camanho 7 analyzed the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee and claim that the presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Angelini et al 8 compared the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot), and traditional instruments instruments.The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot).…”

Uso do fixador externo articulado no tratamento cirúrgico da instabilidade multiligamentar crônica do joelho

“…A principal causa de instabilidade do joelho é, sem dúvida alguma, a lesão do LCA (8) , que isoladamente causa a instabilidade anterolateral (9) .…”

“…Os resultados funcionais da cirurgia de reconstrução do LCA são em sua grande maioria muito bons (9) .…”

“…Várias linhas de pesquisa continuam em desenvolvimento nesse sentido e envolvem também a incorporação de novas tecnologias para o aprimoramento dos resultados, como a navegação auxiliada por computador e a identificação e tratamento de lesões ligamentares associadas ainda pouco diagnosticadas (9,47) .…”