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Video-based computer navigation in knee arthroscopy for patient-specific ACL reconstruction

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Abstract

Purpose

The anterior cruciate ligament tear is a common medical condition that is treated using arthroscopy by pulling a tissue graft through a tunnel opened with a drill. The correct anatomical position and orientation of this tunnel are crucial for knee stability, and drilling an adequate bone tunnel is the most technically challenging part of the procedure. This paper presents the first guidance system based solely on intra-operative video for guiding the drilling of the tunnel.

Methods

Our solution uses small, easily recognizable visual markers that are attached to the bone and tools for estimating their relative pose. A recent registration algorithm is employed for aligning a pre-operative image of the patient’s anatomy with a set of contours reconstructed by touching the bone surface with an instrumented tool.

Results

Experimental validation using ex-vivo data shows that the method enables the accurate registration of the pre-operative model with the bone, providing useful information for guiding the surgeon during the medical procedure. Experiments also demonstrate that the guided drilling of the tunnel leads to errors as low as 2.5 mm in the footprint and \(1.8^\circ \) in orientation, which compares favourably to other works in the field.

Conclusion

The high accuracy and short time overhead evinced by the experimental validation combined with no additional incisions or capital equipment make this video-based computer-aided arthroscopy solution an appealing alternative to the existing approaches.

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Acknowledgements

Funding was provided by Fundação para a Ciência e a Tecnologia (Grant No. PTDC/EEIAUT/3024/2014) and Horizon 2020 (Grant No. 766850).

Author information

Correspondence to Carolina Raposo.

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The authors declare that they have no conflict of interest.

Ethical approval

All studies involving post-mortem subjects followed the procedures for informed consent that are described in the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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The authors thank the Portuguese Science Foundation and COMPETE2020 program for generous funding through project VisArthro (ref.: PTDC/EEIAUT/3024/2014). This paper was also funded by the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 766850.

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Raposo, C., Barreto, J.P., Sousa, C. et al. Video-based computer navigation in knee arthroscopy for patient-specific ACL reconstruction. Int J CARS 14, 1529–1539 (2019) doi:10.1007/s11548-019-02021-0

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Keywords

  • Computer guidance
  • Visual tracking
  • 3D registration
  • Arthroscopy