Research Article | Open Access
Xudong Zhang, Gele Moloney, Paulo Araujo, Evan Langdale, Andrew Churilla, Gustavo Rincon, Julie Mathis, Christopher Harner, "Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery", Journal of Healthcare Engineering, vol. 3, Article ID 620213, 12 pages, 2012. https://doi.org/10.1260/2040-22220.127.116.113
Efficacy of an Intra-Operative Imaging Software System for Anatomic Anterior Cruciate Ligament Reconstruction Surgery
An imaging software system was studied for improving the performance of anatomic anterior cruciate ligament (ACL) reconstruction which requires identifying ACL insertion sites for bone tunnel placement. This software predicts and displays the insertion sites based on the literature data and patient-specific bony landmarks. Twenty orthopaedic surgeons performed simulated arthroscopic ACL surgeries on 20 knee specimens, first without and then with the visual guidance by fluoroscopic imaging, and their tunnel entry positions were recorded. The native ACL insertion morphologies of individual specimens were quantified in relation to CT-based bone models and then used to evaluate the software-generated insertion locations. Results suggested that the system was effective in leading surgeons to predetermined locations while the application of averaged insertion morphological information in individual surgeries can be susceptible to inaccuracy and uncertainty. Implications on challenges associated with developing engineering solutions to aid in re-creating or recognizing anatomy in surgical care delivery are discussed.
- S. Lyman, P. Koulouvaris, S. Sherman, H. Do, L. A. Mandl, and R. G. Marx, “Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery,” Journal of Bone and Joint Surgery American Edition, vol. 91, no. 10, pp. 2321–2328, 2009.
- E. S. Paxton, S. M. Kymes, and R. H. Brophy, “Cost-effectiveness of anterior cruciate ligament reconstruction: a preliminary comparison of single-bundle and double-bundle techniques,” American Journal of Sports Medicine, vol. 38, no. 12, pp. 2417–2425, 2010.
- D. J. Biau, C. Tournoux, S. Katsahian, P. Schranz, and R. Nizard, “ACL reconstruction: a meta-analysis of functional scores,” Clinical Orthopaedic and Related Research, vol. 458, pp. 180–187, 2007.
- K. B. Freedman, M. J. D'Amato, D. D. Nedeff, A. Kaz, and B. R. Bach Jr., “Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts,” American Journal of Sports Medicine, vol. 31, no. 1, pp. 2–11, 2003.
- D. C. Fithian, E. W. Paxton, M. L. Stone et al., “Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee,” American Journal of Sports Medicine, vol. 33, no. 3, pp. 335–346, 2005.
- K. Yasuda, C. F. van Eck, Y. Hoshino, F. H. Fu, and S. Tashman, “Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 1: Basic science,” American Journal of Sports Medicine, vol. 39, no. 8, pp. 1789–1799, 2011.
- B. Forsythe, S. Kopf, A. K. Wong et al., “The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models,” Journal of Bone and Joint Surgery American Edition, vol. 92, no. 6, pp. 1418–1426, 2010.
- P. Sadoghi, A. Kropfl, V. Jansson, P. E. Muller, M. F. Pietschmann, and M. F. Fischmeister, “Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction,” Arthroscopy, vol. 27, no. 3, pp. 355–364, 2011.
- C. F. van Eck, V. M. Schreiber, H. A. Mejia et al., ““Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data,” Arthroscopy, vol. 26, 9 Suppl, pp. S2–S12, 2010.
- Y. Yamamoto, W. H. Hsu, S. L. Woo, A. H. Van Scyoc, Y. Takakura, and R. E. Debski, “Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement,” American Journal of Sports Medicine, vol. 32, no. 8, pp. 1825–1832, 2004.
- W. E. Garrett Jr., M. F. Swiontkowski, J. N. Weinstein et al., “American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix,” Journal of Bone and Joint Surgery American Edition, vol. 88, no. 3, pp. 660–667, 2006.
- G. Rivkin and M. Liebergall, “Challenges of technology integration and computer-assisted surgery,” Journal of Bone and Joint Surgery American Edition, vol. 91, Suppl 1, pp. 13–16, 2009.
- P. Colombet, J. Robinson, P. Christel et al., “Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study,” Arthroscopy, vol. 22, no. 9, pp. 984–992, 2006.
- S. Lorenz, F. Elser, M. Mitterer, T. Obst, and A. B. Imhoff, “Radiologic evaluation of the insertion sites of the 2 functional bundles of the anterior cruciate ligament using 3-dimensional computed tomography,” American Journal of Sports Medicine, vol. 37, no. 12, pp. 2368–2376, 2009.
- S. D. Pietrini, C. G. Ziegler, C. J. Anderson et al., “Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 19, no. 5, pp. 792–800, 2011.
- M. Bernard, P. Hertel, H. Hornung, and T. Cierpinski, “Femoral insertion of the ACL. Radiographic quadrant method,” American Journal of Knee Surgery, vol. 10, no. 1, pp. 14–21, 1997, discussion 21–22.
- A. A. Amis and R. P. Jakob, “Anterior cruciate ligament graft positioning, tensioning and twisting,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 6, Suppl 1, pp. S2–S12, 1998.
- K. Li, M. O'Farrell, D. Martin, S. Kopf, C. Harner, and X. Zhang, “Mapping ligament insertion sites onto bone surfaces in knee by co-registration of CT and digitization data,” Journal of Biomechanics, vol. 42, no. 15, pp. 2624–2626, 2009.
- J. M. Fitzpatrick, J. B. West, and C. R. Maurer Jr., “Predicting error in rigid-body point-based registration,” IEEE Transactions on Medical Imaging, vol. 17, no. 5, pp. 694–702, 1998.
- K. Li, S. Tashman, F. Fu, C. Harner, and X. Zhang, “Automating analyses of the distal femur articular geometry based on three-dimensional surface data,” Annals of Biomedical Engineering, vol. 38, no. 9, pp. 2928–2936, 2010.
Copyright © 2012 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.