Computer-assisted surgery for knee ligament reconstruction (Review)

PLAIN LANGUAGE SUMMARY

Background
The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are centrally located ligaments in the knee. An ACL injury is common in sports such as football and basketball, while PCL injury is far less common. An operation to reconstruct the ACL, usually with a tendon, is one of themost frequently performed orthopaedic procedures. It is very important to performthis operation accurately to obtain a satisfactory outcome and a computer may be able to assist with this. This review set out to examine the evidence for using an additional computer during the operation to help with the positioning of the bone tunnels in which to place the replacement tendon.
Study characteristics
We conducted a comprehensive search of medical literature up to 5 July 2013 to find randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) and quasi-randomized controlled trials (e.g. allocation by hospital record number or date of birth) comparing computer-assisted surgery (CAS) of the ACL or PCL with conventional operating techniques not involving CAS in adults.
Key results and quality of evidence
We found five studies for inclusion in this review. These studies involved 366 participants, mainly female (70%), aged 14 to 53 years. All five trials involved ACL reconstruction.
We were uncertain about the reliability of study findings due to poor reporting of trial methods and, sometimes, results. Our assessment of the quality of the evidence available for individual outcomes ranged from ’moderate’ quality (which means further research may change the estimate) to ’very low’ quality (which means we are very uncertain about the estimate).
The trials provided some moderate quality evidence that there was no difference between computer-assisted surgery and conventional surgery for patient-reported knee function. There was low quality evidence of no difference between the two groups in self-reported function score and very low quality evidence of no difference in a score measuring activity levels. There was low quality evidence of no difference between the two treatment groups in the number of people assessed by clinicians as having a normal or nearly normal knee function at the final follow-up time. No adverse post-surgical events were reported in two trials; this outcome was not reported by the other three trials. CAS took longer to do than conventional surgery (from 9 to 27 minutes longer).
Overall, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome compared with conventional surgery.