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Mueller MM, Tenfelde O, Hinz N, Pagenstert G, Frosch KH, Hoeher J, Akoto R. App-based analysis of the femoral tunnel position in ACL reconstruction using the quadrant method. Arch Orthop Trauma Surg 2024; 144:3137-3144. [PMID: 38795188 DOI: 10.1007/s00402-024-05380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/09/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE The purpose of this study was to examine the intra- and interobserver variability of an app-based analysis of the femoral tunnel position using the quadrant method in primary anterior cruciate ligament reconstruction. MATERIALS AND METHODS Between 12/2020 und 12/2021 50 patients who underwent primary anterior cruciate ligament reconstruction were included in this retrospective study. Intraoperative strictly lateral fluoroscopic images of the knee with marked femoral tunnel were analyzed by four observers using the quadrant method. For retest reliability analysis, measurements were repeated once by 2 observers after 4 weeks. RESULTS The femoral tunnel position of all included patients averaged 27.86% in the depth relation and 15.61% in the height relation. Statistical analysis showed an almost perfect intra- and interobserver reliability in the depth and height relation. The ICC was 0.92 in the depth relation and 0.84 in the height relation. The Pearson's correlation coefficient in the depth and height relation of observer 1 (0.94/0.81) was only slightly different from the Pearson's correlation coefficient of observer 2 (0.92/0.85). The app-based tunnel analysis took on average 59 ± 16 s per measurement. CONCLUSION The femoral tunnel analysis with the app-based quadrant method has an almost perfect intra- and interobserver reliability. By smartphone camera, a fast and highly accurate, if necessary also intraoperative, control of the tunnel position can be performed. LEVEL OF EVIDENCE Level 3-diagnostic retrospective cohort study.
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Affiliation(s)
- Maximilian M Mueller
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany.
| | - Oliver Tenfelde
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
- Sportsclinic Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Nico Hinz
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
| | - Geert Pagenstert
- Clarahof Clinic of Orthopaedic Surgery, University of Basel, Clarahofweg 19a, 4058, Basel, Switzerland
| | - Karl-Heinz Frosch
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Juergen Hoeher
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
- Sportsclinic Cologne, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Ralph Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033, Hamburg, Germany
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
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León-Muñoz VJ, Moya-Angeler J, López-López M, Lisón-Almagro AJ, Martínez-Martínez F, Santonja-Medina F. Integration of Square Fiducial Markers in Patient-Specific Instrumentation and Their Applicability in Knee Surgery. J Pers Med 2023; 13:jpm13050727. [PMID: 37240897 DOI: 10.3390/jpm13050727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Computer technologies play a crucial role in orthopaedic surgery and are essential in personalising different treatments. Recent advances allow the usage of augmented reality (AR) for many orthopaedic procedures, which include different types of knee surgery. AR assigns the interaction between virtual environments and the physical world, allowing both to intermingle (AR superimposes information on real objects in real-time) through an optical device and allows personalising different processes for each patient. This article aims to describe the integration of fiducial markers in planning knee surgeries and to perform a narrative description of the latest publications on AR applications in knee surgery. Augmented reality-assisted knee surgery is an emerging set of techniques that can increase accuracy, efficiency, and safety and decrease the radiation exposure (in some surgical procedures, such as osteotomies) of other conventional methods. Initial clinical experience with AR projection based on ArUco-type artificial marker sensors has shown promising results and received positive operator feedback. Once initial clinical safety and efficacy have been demonstrated, the continued experience should be studied to validate this technology and generate further innovation in this rapidly evolving field.
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Affiliation(s)
- Vicente J León-Muñoz
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | - Joaquín Moya-Angeler
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
- Instituto de Cirugía Avanzada de la Rodilla (ICAR), 30005 Murcia, Spain
| | - Mirian López-López
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, 30100 Murcia, Spain
| | - Alonso J Lisón-Almagro
- Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain
| | - Francisco Martínez-Martínez
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Fernando Santonja-Medina
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Department of Surgery, Pediatrics and Obstetrics & Gynecology, Faculty of Medicine, University of Murcia, 30120 Murcia, Spain
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Affiliation(s)
- Che-Lun Hung
- Institute of Biomedical Informatics National Yang Ming University No. 155, Sec. 2, Linong St., Beitou District Taipei, Taiwan
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