Computer assisted surgery for knee ligament reconstruction
Abstract
Background
Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. The most common technical cause of reconstruction failure is graft malpositioning. Computer assisted surgery aims to aid graft placement.
Objectives
To assess the effects of computer assisted reconstruction surgery versus conventional operating techniques for ACL or posterior cruciate ligament (PCL) deficient knees in adults.
Search methods
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), MEDLINE (1966 to March 2010), EMBASE (1980 to March 2010), CINAHL (1937 to March 2010), article references and prospective trial registers.
Selection criteria
Randomised controlled trials (RCTs) and quasi‐randomised controlled trials that compared computer assisted surgery (CAS) of the ACL and PCL with conventional operating techniques not involving CAS, were included.
Data collection and analysis
Two authors independently screened search results, assessed risk of bias and extracted data. Where appropriate, data were pooled using risk ratios or mean differences, both with 95% confidence intervals.
Main results
Four randomised controlled trials were included (266 participants). All involved ACL reconstructions performed by experienced surgeons. Risk of bias assessment was hampered by poor reporting of trial methods. Pooled data from two trials showed no statistically or clinically significant differences at two years or more follow‐up in self‐reported quality of life outcomes: International Knee Documentation Committee (IKDC) subjective scores (mean difference 2.05, 95% CI ‐2.16 to 6.25) and Lysholm scores (mean difference 2.05, 95% CI ‐2.16 to 6.25). A third trial also found a minimal difference in IKDC subjective scores (mean difference = 0.2). Pooled data from three trials for normal or nearly normal IKDC knee examination grades at final follow‐up showed no significant differences between the two groups (risk ratio 1.01, 95% CI 0.96 to 1.06). No significant differences were found for other objective measures of knee function. The only adverse effects reported were some loss in range of motion in two versus three participants in one trial. CAS use was associated with longer operating times (range 9.3 to 26 minutes).
Authors' conclusions
A favourable effect of computer assisted surgery for cruciate ligament reconstructions of the knee compared with conventional reconstructions could neither be demonstrated nor refuted. There is insufficient evidence to advise for or against the use of CAS. There is a need for improved reporting of future studies of this technology.
Plain language summary
Computer assisted surgery for knee ligament reconstruction
Injury to the anterior cruciate ligament (a centrally located ligament in the knee) is common in sports such as football and basketball. The operative reconstruction of this ligament is one of the most frequently performed orthopaedic procedures. It is very important to perform this operation accurately to obtain a satisfactory outcome. This review set out to examine the evidence for using an additional computer during the operation to help with the positioning of the new anterior cruciate ligament.
Four randomised controlled trials were included. These involved 266 participants aged between 14 and 53 years. All four trials involved anterior cruciate ligament reconstruction. We were unclear about the reliability of study findings due to poor reporting of methods. The trials found no important differences between computer assisted and conventional surgery for patient reported quality of life outcomes. Likewise there were no significant differences between the two treatment groups in the numbers with normal or early normal knee function. The only adverse effects reported were some loss in range of motion in two versus three participants of one trial. Computer assisted surgery resulted in longer operations.
The review concluded that there is insufficient evidence to advise for or against the use of computer assisted surgery in knee ligament reconstruction.
