Search

Generally in the anterior cruciate ligament (ACL) injury assessment specific laxity tests (i.e., Lachman, drawer tests) are clinically performed to evaluate the presence of ligamentous lesion. At present these tests are qualitatively evaluated by the surgeon and some quantitative measurements can be performed only for Lachman/drawer tests by means of dedicated devices. This study aimed to characterize the accuracy of a novel integrated optical-based method that can be used both in intra-operative and in office assessment of ACL injuries; in particular this technology was addressed to measure the loads/torques applied during clinical laxity tests, extending the current possible quantitative evaluations. The system, based on a commercial optical localizer and common springs, was spatially characterized in order to verify displacement/rotation and corresponding applied load/torque measurements. Evaluated limits of agreement between measured and applied loads were from -0.541 to 1.781 N, with a bias of 0.621 N (P = 0.05) in a dedicated clinical-like setup. This approach reported an excellent accuracy in load measurements, showing its possible integration in computer-aided surgery (CAS). [ABSTRACT FROM AUTHOR]

Abstract: In the last 15 years, computer-assisted surgery (CAS) has been used for many purposes during anterior cruciate ligament (ACL) reconstruction, such as tunnel positioning, joint laxity evaluation, and biomechanical studies. This article is an evidence-based literature review of the contribution of such technology to ACL surgery. A search of the PubMed and Medline databases was performed. Articles were classified according to the study design and to the research topic: anatomy, laxity, kinematics, and comparison of surgical techniques. An evidence-based approach was used to verify the clinical usefulness of CAS to ACL surgery. The use of CAS for research purposes was also evaluated. CAS was shown to improve femoral tunnel positioning, even if clinical outcomes showed no differences compared with manual techniques. CAS technology was found to be useful for research purposes in terms of providing a better comprehension of the effect of different ACL reconstructions and of the different bundles on joint laxity, as well as describing tunnel positioning in relation to native ACL insertion. CAS in ACL surgery can improve results at time 0 and can improve knowledge about ACL anatomy and kinematics. Its application remains limited mostly to research purposes because of the invasiveness of the system and the absence of improved clinical results at follow-up. [Copyright &y& Elsevier]

Lachman, drawer, and pivot-shift (PS) tests are important in the assessment of ACL reconstruction. The goal of this work was to analyze the reliability of the PS test using a navigation system, identifying a set of new quantitative parameters and evaluating their clinical relevance. Eighteen patients that underwent anatomic double-bundle ACL reconstruction were included. The new dynamic parameters were: anteroposterior translation of the medial and lateral compartments and the joint center and internal/external and varus/valgus rotations of the joint. For each parameter we measured the peaks and the areas obtained during the test. Intratester repeatability, comparisons of pre- and postoperative laxities, and correlations between the PS peaks and the corresponding peaks obtained with standard static tests were evaluated. Areas, peaks, and static laxity outcomes were compared, grouping patients according to the preoperative International Knee Documentation Committee (IKDC) score. The PS test was reliable in identifying the surgical reconstruction. Correlation analysis showed good coefficients both for pre- and postoperative values. Patients with IKDC grade 'D' had larger areas during the PS compared to patients with grade 'C'. Our analysis is helpful for characterizing patient-specific laxity and surgical performance, thus highlighting the clinical relevance of the PS test. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:164-169, 2010 [ABSTRACT FROM AUTHOR]

This paper describes the features of KIN-nav, a navigation system specifically dedicated to intra-operative evaluation of knee laxity, and assesses the reliability of the system during surgery. The acquisition protocol for its intra-operative use, the original user interface, and the computational methods for elaboration of kinematic data are described in detail. Moreover, an extensive and specific validation of the system was performed in order to evaluate its intra-operative performance and usability. KIN-nav's reliability and accuracy were analyzed in a series of 79 patients undergoing ACL reconstruction. The intra-surgeon repeatability computed for ACL-deficient and reconstructed knees at different flexion angles was less than 0.6° for varus-valgus (VV) rotation, less than 1 mm for AP translation, and less than 1.6° for IE rotation. The inter-surgeon repeatability is less than 2° for VV rotation, 5° for internal-external rotation, and less than 3 mm for AP translation. The proposed method was fast (requiring an additional 10 minutes of surgical time on average), required only a short learning period (5 cases), was minimally invasive, and was robust from the numerical perspective. Our system clearly shows that the use of navigation systems for kinematic evaluation provides useful and complete information on the knee state and test performance, and is simple and reliable to use. The good repeatability in manual kinematic tests is an improvement on the present ability to discriminate knee kinematics intra-operatively, and thus offers the possibility of better discrimination between knee pathologies and the prospect of new surgical applications. [ABSTRACT FROM AUTHOR]

Background: This study describes a novel method for accurate evaluations of knee kinematics during arthroscopic reconstructions of anterior cruciate ligament (ACL). Methods: Quantitative evaluation of knee stability was estimated by experimental validation on 30 volunteers and by statistical analysis of test repeatability. Results: Proposed method present short learning time, is minimally invasive and thus suitable for arthroscopic techniques. Computed laxity showed a repeatability of 1. 5° for varus–valgus, 3° for internal–external, and 2mm for antero–posterior tests. Conclusions: This method represents a reliable quantification of knee kinematics in surgery, able to improve present intra-operative assessment of knee stability. [Copyright &y& Elsevier]

Abstract: Revision total knee arthroplasty (RTKA) is a skill-demanding intervention presenting several technical challenges to the surgeon due to bone deficiencies and lack of anatomical references. Computer-assisted navigation systems can potentially solve these problems. An innovative computer-assisted surgical technique for RTKA is presented. The system is image free. Based on anatomical landmarks acquired on the patient, the system automatically plans the intervention, and provides the surgeon with tools to analyse and modify the proposed plan and to accurately reproduce it on the patient. Although we performed few cases with this navigated procedure, early results obtained demonstrated to be very promising. [Copyright &y& Elsevier]