Computer-Navigated Double-Bundle Anterior Cruciate Ligament Reconstruction

Unsatisfactory results in restoring the rotatory stability in single-bundle anterior cruciate ligament (ACL) reconstruction prompted knee surgeons to develop double-bundle ACL reconstruction, in which both anteromedial and posterolateral bundles were replaced. It has been demonstrated in cadaveric studies that the combination of the anatomically replaced anteromedial and posterolateral grafts functions closer to the normal ACL. In arthroscopic surgery, however, the question how to precisely and consistently place the double-bundle grafts with anatomical orientation still remains unsolved. Although several surgical techniques specifically for the tunnel placement have been proposed for double-bundle reconstruction, the widespread standard has not been established. The aim of computer-navigated surgery is to improve accuracy and decrease the range of surgical variability. The navigation system has already been used successfully for knee endoprosthesis and is applicable to ACL surgery for determining the tunnel position. In addition, the navigation system is capable to provide the real-time data of the knee kinematics during surgery. This sophisticated technology enables surgeons to evaluate the function of the transplanted graft in vivo. This article will provide the technical details of computer-navigated double-bundle ACL reconstruction.