Computer-navigated surgery in anterior cruciate ligament reconstruction: are radiographic outcomes better than conventional surgery?

Abstract

The use of computer navigation systems in anterior cruciate ligament (ACL) has been the subject of debate. However, there is a lack of systematic review to analyze the radiographic outcomes after computer-navigated ACL reconstruction. We searched, in duplicate, Medline, Embase, and Web of Science databases for randomized controlled trials (RCTs)/quasi-RCTs comparing conventional versus computer-navigated ACL reconstruction. Two reviewers independently extracted the data. Radiographic outcomes reported in a majority of included trials were meta-analyzed using the Mantel-Haenszel test statistic. After applying our eligibility criteria, we had 5 trials for systematic review and data synthesis. There was no evidence of statistical heterogeneity between all included studies. Both navigated and conventional ACL reconstructions placed the tibial tunnel in acceptable positions. The risk of notch impingement was reduced in the navigated group in comparison with the conventional group. A computer navigation systems may reduce variation from optimal graft alignment and notch impingement. However, there is a need for further high-quality studies with long-term follow-up, so as to prove the clinical significance of these findings. Level II, systematic review of randomized controlled trials.