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Manual, navigated ACL reconstruction techniques yield similar clinical results

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WASHINGTON — New research shows no advantage in correct tibial tunnel placement using computer-navigated ACL reconstruction compared to the traditional manual approach, but indicates better graft remodeling in computer-assisted cases.

In a prospective randomized study presented at the 27th Annual Meeting of the Arthroscopy Association of North America, here, Dominick Endele, MD, and colleagues examined 40 athletes at approximately 24 months follow-up who underwent either manual ACL reconstruction or ACL reconstruction assisted with the OrthoPilot computer navigation system (Aesculap). The investigators found no significant differences between the groups regarding IKDC 2000, Tegner and Lysholm scores at the follow-up.

An MRI evaluation using the methods described by H.U. Stäulbi, MD, showed that both groups had an average tibial tunnel placement at 46% of the maximal diameter of the tibia. The investigators also found no significant difference between both groups regarding possible intercondylar roof impingement using criteria defined by Stephen M. Howell, MD. Yet, they found that the navigated group showed better graft remodeling on MRI compared to the manual group.

"There was no significant difference in tibial tunnel placement in both groups," Endele said during his presentation. "There was no significant difference in the clinical examination in both groups and there was no significant difference in the subjective evaluation in both groups.

"However on MRI, a better graft remodeling after 24 months could be seen [in the navigation group]. But computer navigation did not make any additional improvements to the correct tibial drilling tunnel placement in our study," he said.

For more information:

• Endele D, Mauch F, Becker U. Anterior cruciate ligament (ACL) reconstruction with and without computer navigation: A clinical and MRI evaluation two years after surgery. Paper SS31. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.