Anterior cruciate ligament reconstruction with and without computer navigation: a clinical and magnetic resonance imaging evaluation 2 years after surgery.
OBJECTIVE
The purpose of this study was to evaluate the benefits of computer navigation on tunnel placement during anterior cruciate ligament reconstruction.


METHODS
A prospective, randomized, controlled study comparing computer navigation with manual operation was performed between December 2003 and April 2004. We assigned 20 patients to the computer navigation group and 20 patients to the manual navigation group. Surgery was performed by use of a patellar tendon autograft with press-fit fixation. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel at 4 days postoperatively. Outcomes were evaluated with International Knee Documentation Committee 2000, Tegner, and Lysholm scoring. There was an additional magnetic resonance imaging (MRI) evaluation of tunnel placement and graft quality at the most recent follow-up, approximately 24 months after surgery.


RESULTS
The postoperative radiographs and 2-year postoperative MRI scans showed no differences between groups for tibial or femoral tunnel placement. In both groups the mean tibial tunnel placement was 46% of the maximal diameter of the tibia. There were no significant differences between groups for objective and subjective outcomes scoring. Although some qualitative differences existed between groups with respect to MRI graft appearance at 2 years, this had no correlation with overall results.


CONCLUSIONS
No significant differences were found between computer-assisted and manually navigated anterior cruciate ligament reconstruction with regard to tunnel placement and clinical results at a mean of 2 years postoperatively.


METHODS
Level I, randomized, single-blinded, controlled trial.
Sportklinik Stuttgart, Clinic for Orthopedic Surgery and Sports Traumatology, Stuttgart 70372, Germany. d.endele@mac.com
Dominick
D
Endele
Christian
C
Jung
Ulrich
U
Becker
Gerhard
G
Bauer
Frieder
F
Mauch
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000886:Anthropometry / Q000295:instrumentation / Q000379:methods; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000637:transplantation; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult