J Korean Orthop Assoc.  2009 Apr;44(2):201-209.

In Vivo Comparison of Isometricity between Navigational and Conventional Technique in an ACL Reconstruction

• Song EK
• Seon JK
• Park SJ
• Cho YJ
• Park CH

Abstract

PURPOSE
To compare isometricity between the navigational and conventional technique during an anterior cruciate ligament (ACL) reconstruction before fixating the graft. MATERIALS AND METHODS: Twenty-three patients with an ACL insufficiency were enrolled in this study. After finishing the tibial tunnel preparation using a navigational technique, a femoral tunnel site was marked using either the navigational (Orthopilot(R)) or conventional (Arthrex(R) 5 mm off-set guide) technique. After passing the suture material attached to the guide pin through each femoral site, isometric tests were then performed using a specially designed device during full range of motion of the knee. RESULTS: An mean isometricity after the navigational and the conventional technique was 3.0 mm and 4.6 mm respectively. The isometricity after the navigational technique was significantly better than that after the conventional technique (p=0.000). The navigational isometric point was usually 0 to 5 mm anterior or antero-lateral to that at the point of the conventional technique. The mean distance between the tunnels by two techniques was 1.35 mm. There was a strong positive correlation between the difference in isometicity and the positional relationship of the femoral tunnel (r2=0.778, p=0.000). CONCLUSION: An ACL reconstruction using the navigational technique provides better isometricity than that obtained using the conventional technique.

Keyword

Navigation; ACL reconstruction; Isometricity

MeSH Terms

Anterior Cruciate Ligament
Humans
Knee
Range of Motion, Articular
Sutures
Transplants

Figure

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  Fig. 1 Isometer consisting of a main frame, indicator and guide. Select the proper sized guide according to the size of tibial tunnel, indicator with regular tension during knee ROM, indicates scale drawn on main frame, scale differences imply isometricity. Measure scale differences by knee flexion & extension, and maximum difference is calculated in mm as isometricity.

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  Fig. 2 Tibial and femoral passive transmitter is fixed securely. 4 balls located in transmitter reflect infrared rays. Reflected infrared rays from the generator were detected by camera in main system.

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  Fig. 3 Tibial tunneling was done by navigational technique. (A) This is a tibial tunneling guide of navigational technique. (B) It showed the information indicated by tibial guide. This tibial tunnel was located in 20 degrees in coronal plane, 55 degrees in sagital plane, 8 mm anterior to PCL anterior edge, and 48% in medial tibial plateau.

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  Fig. 4 Femoral tunneling was done by conventional technique with Arthrex® 5 mm off-set manual guide. Femoral tunneling was made toward 10 : 30 or 1 : 30 O'clock.

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  Fig. 5 Fixation the guide attached by Ethibond® #5 through femoral cortex. Femoral side of Ethibond® #5 was firmly fixed to ACL attach site, act like reconstructed ACL at same location during the knee ROM. The length change was equal to isometricity of reconstructed ACL.

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  Fig. 6 Isometricity was measured under knee ROM exercise. Pass the other end of Ethibond® #5 through tibial tunnel, fixation the Ethibond® #5 by mosquito after equipment isometer through tibial tunnel. White arrow indicated isometer, inserted to the tibial tunnel.

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  Fig. 7 (A) Femoral tunnel was made by navigational technique. The appropriate isometric points by navigational technique is more antero-lateral than conventional technique. (B) Isometricity is 3 mm, and 1 : 30 O'clock position, 9 mm anterior to over the top position.

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  Fig. 8 Positional relationship was measured by arthroscopy with a probe. (A) Black arrow indicats femoral tunnel by conventional technique and white arrow indicats femoral tunnel by navigational technique. Femoral tunnel by navigation technique was located more anterolateral position than by conventional technique, and difference between two tunneling was about 2 mm. (B) Femoral tunnel by navigation technique was located more anterior position than by conventional technique.

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