Knee Surg Relat Res.  2014 Sep;26(3):168-176. 10.5792/ksrr.2014.26.3.168.

Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using a Three-Dimensional Fluoroscopic Navigation System

• Taketomi S
• Inui H
• Sanada T
• Nakamura K
• Yamagami R
• Masuda H
• Tanaka S
• Nakagawa T

• KMID: 2223276
• DOI: http://doi.org/10.5792/ksrr.2014.26.3.168

Abstract

INTRODUCTION
Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. This study describes a surgical technique used to create an anatomical femoral socket with a three-dimensional (3D) fluoroscopy based navigation system during technically demanding remnant-preserving ACL reconstruction. SURGICAL TECHNIQUE: After a reference frame was attached to the femur, an intraoperative image of the distal femur was obtained, transferred to the navigation system and reconstructed into a 3D image. A navigation computer helped the surgeon visualize the entire lateral wall of the femoral notch and lateral intercondylar ridge, even when the remnant of the ruptured ACL impeded arthroscopic visualization of the bone surface. When a guide was placed, the virtual femoral tunnel overlapped the reconstructed 3D image in real time; therefore, only minimal soft tissue debridement was required.
MATERIALS AND METHODS
We treated 47 patients with remnant-preserving ACL reconstruction using this system. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D computed tomography imaging.
RESULTS
The femoral socket locations were considered to be an anatomical footprint in accordance with previous cadaveric studies.
CONCLUSIONS
The 3D fluoroscopy-based navigation can assist surgeons in creating anatomical femoral sockets during remnant-preserving ACL reconstruction.

Keyword

Anterior cruciate ligament; Remnant; Computer-assisted surgery; Three-dimensional computed tomography

MeSH Terms

Anterior Cruciate Ligament
Anterior Cruciate Ligament Reconstruction*
Cadaver
Cell Proliferation
Debridement
Femur
Fluoroscopy
Humans
Proprioception
Surgery, Computer-Assisted