RESUMEN
Reconstruction of the anterior cruciate ligament is a delicate task for which many different techniques have been proposed. A system consisting of a computer and a three-dimensional optical sensor is proposed to help the surgeon control the placement of a graft. This system can be used to minimize anisometry of the graft and avoid notch impingement. The same system, which had been validated by previous testing on 20 fresh human anatomic specimen knees, was tested on 23 patients who had an anterior cruciate ligament injury. Tunnel placement was performed using the standard technique of Morgan et al and was measured with the computer based system. It was found that all cases had different configurations of tibial and femoral placement. The computer based anisometry measurements ranged from 1.9 mm to 8.8 mm in the anterior part of the graft, and from 1 mm to 13 mm in the centers of the tunnels. Using the computer retrospectively, it was possible to find configurations of the graft in all cases that avoid notch impingement, with anisometry values ranging from 1.3 mm to 3.7 mm. This study shows that a computer based system can be a useful tool for routine anterior cruciate ligament reconstruction and can be useful for research purposes.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Procedimientos de Cirugía Plástica , Terapia Asistida por Computador , Ligamento Cruzado Anterior/patología , Ligamento Cruzado Anterior/fisiopatología , Lesiones del Ligamento Cruzado Anterior , Artroscopía , Sistemas de Computación , Fémur/fisiopatología , Fémur/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Cuidados Intraoperatorios , Traumatismos de la Rodilla/patología , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/patología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Óptica y Fotónica/instrumentación , Rango del Movimiento Articular , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Terapia Asistida por Computador/instrumentación , Terapia Asistida por Computador/métodos , Tibia/fisiopatología , Tibia/cirugíaRESUMEN
PURPOSE: The correct placement of the mandibular condyle in the glenoid fossa during the osteosynthesis after the sagittal ramus osteotomy is often a problem. This article describes a computer-assisted positioning device. METHODS: The procedure is based on the use of a three-dimensional optical localizer to establish the condylar segment position. The operative procedure is only slightly different from the usual. RESULTS: The system is very easy to use, it does not require preoperative data acquisition, and the accuracy obtained is in fractions of a millimeter.
Asunto(s)
Cóndilo Mandibular/cirugía , Osteotomía , Terapia Asistida por Computador , Clavos Ortopédicos , Relación Céntrica , Diseño de Equipo , Humanos , Cóndilo Mandibular/patología , Movimiento , Osteotomía/métodos , Rotación , Siliconas , Terapia Asistida por Computador/instrumentación , TitanioRESUMEN
Anterior cruciate ligament reconstruction is a delicate task. The procedure of choice is the patellar tendon bone autograft, but an anisometric position of this tendon often leads to failure. We allows positioning of the central part of the ligament graft at the least anisometric sites. The system uses a workstation and a three-dimensional optical localizer to create images that represent knee kinematics. The surgeon uses these images to guide the surgery. This technique has been validated on eight cadavers and 12 patients.