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Computer-Assisted Surgery Is Not More Accurate or Precise Than Conventional Arthroscopic ACL Reconstruction: A Prospective Randomized Clinical Trial

Meuffels, Duncan E. MD, PhD; Reijman, Max PhD; Verhaar, Jan A.N. MD, PhD

Journal of Bone & Joint Surgery - American Volume: 5 September 2012 - Volume 94 - Issue 17 - p 1538–1545
doi: 10.2106/JBJS.K.00878
Scientific Articles
Supplementary Content

Background: Accurate and precise tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction. A new development, computer-assisted surgery, aids in placement of the ACL bone tunnels during surgery. Our hypothesis was that computer-assisted ACL reconstruction would allow more accurate and precise tunnel placement compared with conventional surgery.

Methods: In a prospective, double-blind, randomized clinical study, 100 patients eligible for ACL reconstruction with a transtibial technique were stratified by surgeon and randomized to either conventional or computer-assisted surgery. Measurement of femoral and tibial tunnel placement with use of three-dimensional computed tomography (CT) was used as the primary outcome to compare conventional ACL surgery with computer-assisted surgery.

Results: The placement of the femoral tunnel did not differ between groups (mean, 39.7% of the proximal-distal distance on the intracondylar axis [Blumensaat line] in the conventional group compared with 39.0% in the computer-assisted surgery group; p = 0.70). The anterior-posterior positioning of the tibial tunnel on the tibial plateau also did not differ significantly (38.9% in the conventional group compared with 38.2% in the computer-assisted surgery group; p = 0.58). There was no significant difference in the precision of either the femoral or the tibial tunnel placement between the two groups.

Conclusions: There was no significant difference in either the accuracy or the precision of tunnel placement between conventional and computer-assisted ACL reconstruction.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for D.E. Meuffels:

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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