Clinical integration of computer-assisted technology for arthroscopic anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) reconstruction with an autogenous graft through the use of a minimally invasive endoscopic approach has become the standard in ACL replacement. The arthroscopically assisted technique causes minimal trauma and can sometimes be performed on an outpatient basis. There have been, however, alarming reports of high misplacement rates of these grafts. These misplacements can partially be attributed to the restricted local view provided by arthroscopy, which does not give the surgeon a global overview of ligament position with respect to knee anatomy. Thirty-degree endoscopes, lens distortions, and the difficulty of judging depth from the 2-dimensional (2-D) view makes mental orientation of internal structures with respect to desired reattachment sites difficult. Another problem is the lack of a general consensus on the best type of graft and on the proper placement of these grafts. As a result, there is a rather large variety of surgical techniques and a variety of different graft types. To help solve these problems, we have developed a computer-assisted system to aid surgeons in planning and intraoperative placement of ligament grafts.