This article is more than 5 years old. Information may no longer be current.
Navigation system optimized drilling tunnel positionin
The integration of additional safety elements helps to project impingement situations in advance.
Click Here to Manage Email Alerts
ORLANDO, U.S.A. —
Computer-assisted navigation for anterior cruciate ligament replacement has
helped surgeons to optimally place drilling tunnels more accurately. Findings
from a recent German study showed that surgeons who used the technology fared
as well or better than those who didn’t.
Jürgen Eichhorn, MD, and other orthopaedic surgeons at Orthopädische Gemeinschaftspraxis in Straubing, Germany, have used the OrthoPilot (Aesculap/B. Braun) computer-assisted navigation system for three years, and recently compared its use in 300 patients with that of 300 patients who underwent surgery without the device.
“The advantages are precise positioning of the drill holes and projecting the intercondylar notch in full extension above the tibial plateau,” Eichhorn said.
Improving navigation
Seeking an improvement in bone site navigation, Eichhorn and his colleagues use the computer-assisted navigation system for total knee (TKA) and total hip arthroplasty (THA). They also developed software for anterior cruciate ligament (ACL) surgery, citing that 10% of the procedures in Germany are done by surgeons who perform fewer than 20 ACL reconstructions a year.
The physicians compiled data on 300 navigated vs. 300 non-navigated cases. All surgeons who used the system in the study had experience with the OrthoPilot. All tunnels except for two were in the optimal Harner scale, which evaluates tunnel placement.
Eight orthopaedic fellows with diagnostic and arthroscopy and probe experience were chosen; they each attempted 10 tunnel placements. The researchers found no difference between fellows and there was no difference in accuracy for each attempt.
Steps of development
According to Eichhorn, who spoke at the Arthroscopy Association of North America 23rd Annual Meeting, the advantage of the system is that it’s “one device with several indications.”
Developmental steps over three years began with the surgeons looking for isometricity in the femoral tunnel. “We looked for a more anatomical approach,” said Eichhorn, noting that the OrthoPilot navigates the tibial and femoral tunnels.
For an additional element of safety, they included X-rays in the preoperative planning stage to give the computer the correct dimensions. “If you probe the wrong points, the computer will say that you have to do it again,” Eichhorn said. This gave them “a navigation stability path that is more precise than KT-1000,” he added.
While using the device, the surgeon can utilize a monitor screen that projects information onto an animated navigation screen. The system can project the intercondylar notch over the tibial plateau in full extension, telling the surgeon where to place the drill hole. It can also give a medial-to-lateral view for ACL surgery or femoral tunnel placement.
In real time, “You place the drilling device, playing [it] like a computer game; you just have to find the right spot,” he said.
Eichhorn and his colleagues are considering future uses for the OrthoPilot, including PCL navigation, cartilage mapping and drilling of retrograde osteochondritis dissecans lesions.
Dr. Eichhorn has a financial interest in the OrthoPilot and is a paid consultant to Aesculap/B. Braun.
For more information:
- Eichhorn J. Three years of experience with computer navigation-assisted positioning of drilling tunnels in anterior cruciate ligament replacement. Presented at the Arthroscopy Association of North America 23rd Annual Meeting. April 22-25, 2004. Orlando, U.S.A.