Computer Navigation for Pediatric Femoral ACL Tunnel Placement.
ACL
computer navigation
femoral tunnel
pediatric
skeletally immature
Journal
The Iowa orthopaedic journal
ISSN: 1555-1377
Titre abrégé: Iowa Orthop J
Pays: United States
ID NLM: 8908272
Informations de publication
Date de publication:
2019
2019
Historique:
entrez:
16
8
2019
pubmed:
16
8
2019
medline:
7
2
2020
Statut:
ppublish
Résumé
To compare accuracy, time and radiation exposure of pediatric femoral tunnel placement using computer navigation with a traditional freehand technique. A single all-epiphyseal femoral tunnel was placed in the distal femur of 20 Sawbones™ adolescent knee models. Ten tunnels were drilled using standard fluoroscopic guidance (FG). An additional 10 tunnels were drilled using 3D fluoroscopic computer navigation (CN). Both techniques aimed to match an exact point described by the quadrant system of Bernard. Time to perform the procedure was recorded as were number of single shot fluoroscopic images and approximate effective radiation doses. The deviation from ideal femoral tunnel position was on average 6.4 ± 4.2 mm for FG tunnels and 2.7 ± 3.1 mm for CN tunnels (p<0.05) . There was no violation of the femoral growth plate using either technique. The surgeon was exposed to 17 ± 5.3 and 3 ± 0.66 single fluoroscopy exposures for FG and CN guidance, respectively (p<0.05). However, the effective dose for the CN because of the acquisition of 3D images was 0.52±.003 mSv and for FG was only 0.09mSv ± .027 (p <0.001). CN however required on average 12.5 ± 3.4 min compared to 4.6 ± 1.7 for FG (p<0.05) to complete drilling of the tunnel. CN achieves a more accurate epiphyseal femoral ACL tunnel position but requires more time to complete and has a higher effective radiation dose than FG. Whether the CN ACL tunnels can translate to improved clinical outcomes is still unknown.
Sections du résumé
Background
To compare accuracy, time and radiation exposure of pediatric femoral tunnel placement using computer navigation with a traditional freehand technique.
Methods
A single all-epiphyseal femoral tunnel was placed in the distal femur of 20 Sawbones™ adolescent knee models. Ten tunnels were drilled using standard fluoroscopic guidance (FG). An additional 10 tunnels were drilled using 3D fluoroscopic computer navigation (CN). Both techniques aimed to match an exact point described by the quadrant system of Bernard. Time to perform the procedure was recorded as were number of single shot fluoroscopic images and approximate effective radiation doses.
Results
The deviation from ideal femoral tunnel position was on average 6.4 ± 4.2 mm for FG tunnels and 2.7 ± 3.1 mm for CN tunnels (p<0.05) . There was no violation of the femoral growth plate using either technique. The surgeon was exposed to 17 ± 5.3 and 3 ± 0.66 single fluoroscopy exposures for FG and CN guidance, respectively (p<0.05). However, the effective dose for the CN because of the acquisition of 3D images was 0.52±.003 mSv and for FG was only 0.09mSv ± .027 (p <0.001). CN however required on average 12.5 ± 3.4 min compared to 4.6 ± 1.7 for FG (p<0.05) to complete drilling of the tunnel.
Concluson
CN achieves a more accurate epiphyseal femoral ACL tunnel position but requires more time to complete and has a higher effective radiation dose than FG. Whether the CN ACL tunnels can translate to improved clinical outcomes is still unknown.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
121-129Déclaration de conflit d'intérêts
Disclosures: The authors report no potential conflicts of interest related to this study.
Références
J Arthroplasty. 2005 Oct;20(7):832-9
pubmed: 16230232
J Bone Joint Surg Am. 2011 Apr 20;93(8):e39
pubmed: 21508274
Knee Surg Sports Traumatol Arthrosc. 2011 Jun;19(6):887-92
pubmed: 20852843
Knee Surg Sports Traumatol Arthrosc. 2008 May;16(5):442-8
pubmed: 18292988
Am J Sports Med. 2011 Dec;39(12):2582-7
pubmed: 21917611
Arch Orthop Trauma Surg. 2011 Mar;131(3):297-302
pubmed: 20603710
Int Orthop. 2013 Feb;37(2):233-8
pubmed: 23314335
Br J Sports Med. 2013 May;47(8):488-94
pubmed: 23446640
J Knee Surg. 2012 Nov;25(5):361-8
pubmed: 23150344
Am J Sports Med. 2007 Oct;35(10):1756-69
pubmed: 17761605
J Bone Joint Surg Br. 2006 Jul;88(7):972-5
pubmed: 16799007
Open Orthop J. 2010 Aug 06;4:228-33
pubmed: 21249166
J Pediatr Orthop. 2002 Jul-Aug;22(4):452-7
pubmed: 12131440
J Am Acad Orthop Surg. 2013 Feb;21(2):78-87
pubmed: 23378371
Comput Assist Surg (Abingdon). 2017 Dec;22(1):10-13
pubmed: 28019109
Arch Orthop Trauma Surg. 2008 Sep;128(9):945-50
pubmed: 17874244
Am J Sports Med. 2011 May;39(5):964-71
pubmed: 21257848
J Pediatr Orthop. 2018 Feb;38(2):e61-e65
pubmed: 29189529
J Bone Joint Surg Br. 2002 Jan;84(1):38-41
pubmed: 11837830
Sports Med Arthrosc Rev. 2008 Jun;16(2):108-10
pubmed: 18480731
J Bone Joint Surg Am. 2012 Sep 5;94(17):1538-45
pubmed: 22832975
Arthroscopy. 2002 Nov-Dec;18(9):955-9
pubmed: 12426537
Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1496-500
pubmed: 20182870
Int J Med Robot. 2014 Dec;10(4):438-46
pubmed: 24677574
Am J Knee Surg. 1997 Winter;10(1):14-21; discussion 21-2
pubmed: 9051173
Comput Aided Surg. 2001;6(5):279-89
pubmed: 11892004
Clin Orthop Relat Res. 2010 Sep;468(9):2419-29
pubmed: 20521129
J Bone Joint Surg Am. 2004 Sep;86-A Suppl 1(Pt 2):201-9
pubmed: 15466760
Radiology. 2008 Jul;248(1):254-63
pubmed: 18566177
J Orthop Trauma. 2005 May-Jun;19(5):317-22
pubmed: 15891540
J Bone Joint Surg Br. 1995 Nov;77(6):890-4
pubmed: 7593101
J Bone Joint Surg Am. 2013 Mar 6;95(5):e28
pubmed: 23467876
J Bone Joint Surg Am. 2005 Nov;87(11):2371-9
pubmed: 16264110
Arthroscopy. 2008 May;24(5):569-78
pubmed: 18442690
Arthroscopy. 2012 Nov;28(11):1710-7
pubmed: 22951370
Sports Med Arthrosc Rev. 2008 Jun;16(2):67-76
pubmed: 18480725