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Duncan E Meuffels - One of the best experts on this subject based on the ideXlab platform.

  • Computer Assisted Surgery for knee ligament reconstruction
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Vincent Eggerding, Max Reijman, Jan A N Verhaar, Rob J P M Scholten, Duncan E Meuffels
    Abstract:

    BACKGROUND Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. The most common technical cause of reconstruction failure is graft malpositioning. Computer-Assisted Surgery (CAS) aims to improve the accuracy of graft placement. Although posterior cruciate ligament (PCL) injury and reconstruction are far less common, PCL reconstruction has comparable difficulties relating to graft placement. This is an update of a Cochrane review first published in 2011. OBJECTIVES To assess the effects of Computer-Assisted reconstruction Surgery versus conventional operating techniques for ACL or PCL injuries in adults. SEARCH METHODS For this update, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (from 2010 to July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2013), MEDLINE (from 2010 to July 2013), EMBASE (from 2010 to July 2013), CINAHL (from 2010 to July 2013), article references and prospective trial registers. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-randomized controlled trials that compared CAS for ACL or PCL reconstruction versus conventional operating techniques not involving CAS. DATA COLLECTION AND ANALYSIS Two authors independently screened search results, assessed the risk of bias in the studies and extracted data. Where appropriate, we pooled data using risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI). MAIN RESULTS The updated search resulted in the inclusion of one new study. This review now includes five RCTs with 366 participants. There were more female than male participants (70% were female); their ages ranged from 14 to 53 years. All trials involved ACL reconstructions performed by experienced surgeons.Assessing the studies' risk of bias was hampered by poor reporting of trial methods, and consequently several studies were judged to be 'unclear' for several types of bias. One trial presenting primary outcome data was at high risk of detection bias from lack of clinician blinding and attrition bias from an unaccounted loss to follow-up at two years.We found moderate quality evidence (three trials, 193 participants) of no clinically relevant difference between CAS and conventional Surgery in International Knee Documentation Committee (IKDC) subjective scores (self-reported measure of knee function; scale of 0 to 100 where 100 was best function). Pooled data from two of these trials (120 participants) showed a small, but clinically irrelevant difference favouring CAS (MD 2.05, 95% CI -2.16 to 6.25). A third trial (73 participants) also found minimal difference in IKDC subjective scores (reported MD 0.2).We found low quality evidence (two trials, 120 participants) showing no difference between the two groups in Lysholm scores, also measured on a scale 0 to 100 where 100 is best function (MD 0.25, 95% CI -3.75 to 4.25). We found very low quality evidence (one trial, 40 participants) showing no difference between the two groups in Tegner scores. We found low quality evidence (three trials, 173 participants) showing the majority of participants in both groups were assessed as having normal or nearly normal knee function (86/87 with CAS versus 84/86 with no CAS; RR 1.01, 95% CI 0.96 to 1.06).Similarly, no differences were found for our secondary outcome measures of knee stability, loss in range of motion and tunnel placement. None of the trials reported on re-operation.No adverse post-surgical events were reported in two trials (133 participants); this outcome was not reported by the other three trials.CAS use was associated with longer operating times compared with conventional operating techniques: the mean difference in operating times reported in the studies ranged between 9 and 27 minutes. AUTHORS' CONCLUSIONS From the available evidence, we are unable to demonstrate or refute a favourable effect of CAS for cruciate ligament reconstructions of the knee compared with conventional reconstructions. However, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome. There is a need for improved reporting of future studies of this technology.

  • Computer Assisted Surgery for knee ligament reconstruction review
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Vincent Eggerding, Max Reijman, Jan A N Verhaar, Rob J P M Scholten, Duncan E Meuffels
    Abstract:

    _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.

  • Computer Assisted Surgery is not more accurate or precise than conventional arthroscopic acl reconstruction a prospective randomized clinical trial
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Duncan E Meuffels, Jan A N Verhaar
    Abstract:

    Background: Accurate and precise tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction.Anewdevelopment,Computer-Assisted Surgery,aidsinplacementof theACLbonetunnelsduringSurgery. Our hypothesis was that Computer-Assisted ACL reconstruction would allow more accurate and precise tunnel placement compared with conventional Surgery. Methods: In a prospective, double-blind, randomized clinical study, 100 patients eligible for ACL reconstruction with a transtibial technique were stratified by surgeon and randomized to either conventional or Computer-Assisted Surgery. Measurement of femoral and tibial tunnel placement with use of three-dimensional computed tomography (CT) was used as the primary outcome to compare conventional ACL Surgery with Computer-Assisted Surgery. Results: The placement of the femoral tunnel did not differ between groups (mean, 39.7% of the proximal-distal distance ontheintracondylar axis[Blumensaatline]intheconventional groupcomparedwith39.0%intheComputer-AssistedSurgery group; p = 0.70). The anterior-posterior positioning of the tibial tunnel on the tibial plateau also did not differ significantly (38.9% in the conventional group compared with 38.2% in the Computer-Assisted Surgery group; p = 0.58). There was no significant difference in the precision of either the femoral or the tibial tunnel placement between the two groups. Conclusions: There was no significant difference in either the accuracy or the precision of tunnel placement between conventional and Computer-Assisted ACL reconstruction. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  • Computer Assisted Surgery for knee ligament reconstruction protocol
    Cochrane Database of Systematic Reviews, 2009
    Co-Authors: Duncan E Meuffels, Max Reijman, Jan A N Verhaar
    Abstract:

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of Computer Assisted reconstruction Surgery versus conventional operating techniques for ACL or PCL deficient knees in adults. We will test these effects according to the following specific subgroups: 1. System used for CAS (e.g. per-operative use of X-rays, pre-operative use of radiology (CT, MRI, X-rays), per-operative landmarks or bone morphing). 2. Type of ligament reconstruction: ACL or PCL, or both.

Robert Wenwei Hsu - One of the best experts on this subject based on the ideXlab platform.

  • differences in component and limb alignment between Computer Assisted and conventional Surgery total knee arthroplasty
    Knee Surgery Sports Traumatology Arthroscopy, 2014
    Co-Authors: Tsanwen Huang, Kuoti Peng, Robert Wenwei Hsu, Kuochin Huang, Mel S Lee
    Abstract:

    Purpose Marked coronal femoral bowing may bear a risk for mal-alignment of femoral component and reconstructed mechanical axis (MA) by using conventional instrumentations. The aim of this study was to investigate the usefulness of Computer-Assisted Surgery–total knee arthroplasty (CAS-TKA) under this circumstance.

  • total knee arthroplasty with use of Computer Assisted navigation compared with conventional guiding systems in the same patient radiographic results in asian patients
    Journal of Bone and Joint Surgery American Volume, 2011
    Co-Authors: Tsanwen Huang, Weihsiu Hsu, Kuoti Peng, Robert Wenwei Hsu, Yijan Weng, Wunjer Shen
    Abstract:

    Background: The value of Computer-Assisted Surgery in total knee arthroplasty for arthritic knees continues to be debated. We hypothesized that the usefulness of Computer assistance is related to the magnitude of the deviation from the preoperative mechanical axis and that Computer-Assisted Surgery may be beneficial under certain circumstances. Methods: Patients with bilateral knee osteoarthritis and genu varus deformity who were to have staged bilateral total knee arthroplasty were enrolled. The patients randomly underwent Computer-Assisted total knee arthroplasty in one knee and conventional total knee arthroplasty in the contralateral knee. The two methods were compared for accuracy of placement of the components and lower extremity alignment after total knee arthroplasty as determined by six radiographic parameters. Results: One hundred and thirteen patients (226 knees) met the inclusion criteria. For patients with a preoperative mechanical axis deviation of 20°, the reconstructed mechanical axes were significantly closer to normal in the Computer-Assisted total knee arthroplasty group. Significant results were also noted in the anatomical axes, femoral valgus angle, and femoral flexion angle. Furthermore, a higher percentage of knees in which Computer-Assisted Surgery was used had restoration of the mechanical axis within 3° of neutral. Conclusions: Computer-Assisted Surgery was a valuable adjunct for obtaining proper alignment during total knee arthroplasty in patients with knee osteoarthritis with severe varus deformity. Conventional total knee arthroplasty was as effective as Computer-Assisted total knee arthroplasty for obtaining proper alignment in patients with a minor to moderate deformity. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Jan A N Verhaar - One of the best experts on this subject based on the ideXlab platform.

  • Computer Assisted Surgery for knee ligament reconstruction
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Vincent Eggerding, Max Reijman, Jan A N Verhaar, Rob J P M Scholten, Duncan E Meuffels
    Abstract:

    BACKGROUND Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopaedic procedures. The most common technical cause of reconstruction failure is graft malpositioning. Computer-Assisted Surgery (CAS) aims to improve the accuracy of graft placement. Although posterior cruciate ligament (PCL) injury and reconstruction are far less common, PCL reconstruction has comparable difficulties relating to graft placement. This is an update of a Cochrane review first published in 2011. OBJECTIVES To assess the effects of Computer-Assisted reconstruction Surgery versus conventional operating techniques for ACL or PCL injuries in adults. SEARCH METHODS For this update, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (from 2010 to July 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2013), MEDLINE (from 2010 to July 2013), EMBASE (from 2010 to July 2013), CINAHL (from 2010 to July 2013), article references and prospective trial registers. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-randomized controlled trials that compared CAS for ACL or PCL reconstruction versus conventional operating techniques not involving CAS. DATA COLLECTION AND ANALYSIS Two authors independently screened search results, assessed the risk of bias in the studies and extracted data. Where appropriate, we pooled data using risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CI). MAIN RESULTS The updated search resulted in the inclusion of one new study. This review now includes five RCTs with 366 participants. There were more female than male participants (70% were female); their ages ranged from 14 to 53 years. All trials involved ACL reconstructions performed by experienced surgeons.Assessing the studies' risk of bias was hampered by poor reporting of trial methods, and consequently several studies were judged to be 'unclear' for several types of bias. One trial presenting primary outcome data was at high risk of detection bias from lack of clinician blinding and attrition bias from an unaccounted loss to follow-up at two years.We found moderate quality evidence (three trials, 193 participants) of no clinically relevant difference between CAS and conventional Surgery in International Knee Documentation Committee (IKDC) subjective scores (self-reported measure of knee function; scale of 0 to 100 where 100 was best function). Pooled data from two of these trials (120 participants) showed a small, but clinically irrelevant difference favouring CAS (MD 2.05, 95% CI -2.16 to 6.25). A third trial (73 participants) also found minimal difference in IKDC subjective scores (reported MD 0.2).We found low quality evidence (two trials, 120 participants) showing no difference between the two groups in Lysholm scores, also measured on a scale 0 to 100 where 100 is best function (MD 0.25, 95% CI -3.75 to 4.25). We found very low quality evidence (one trial, 40 participants) showing no difference between the two groups in Tegner scores. We found low quality evidence (three trials, 173 participants) showing the majority of participants in both groups were assessed as having normal or nearly normal knee function (86/87 with CAS versus 84/86 with no CAS; RR 1.01, 95% CI 0.96 to 1.06).Similarly, no differences were found for our secondary outcome measures of knee stability, loss in range of motion and tunnel placement. None of the trials reported on re-operation.No adverse post-surgical events were reported in two trials (133 participants); this outcome was not reported by the other three trials.CAS use was associated with longer operating times compared with conventional operating techniques: the mean difference in operating times reported in the studies ranged between 9 and 27 minutes. AUTHORS' CONCLUSIONS From the available evidence, we are unable to demonstrate or refute a favourable effect of CAS for cruciate ligament reconstructions of the knee compared with conventional reconstructions. However, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome. There is a need for improved reporting of future studies of this technology.

  • Computer Assisted Surgery for knee ligament reconstruction review
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Vincent Eggerding, Max Reijman, Jan A N Verhaar, Rob J P M Scholten, Duncan E Meuffels
    Abstract:

    _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.

  • Computer Assisted Surgery is not more accurate or precise than conventional arthroscopic acl reconstruction a prospective randomized clinical trial
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Duncan E Meuffels, Jan A N Verhaar
    Abstract:

    Background: Accurate and precise tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction.Anewdevelopment,Computer-Assisted Surgery,aidsinplacementof theACLbonetunnelsduringSurgery. Our hypothesis was that Computer-Assisted ACL reconstruction would allow more accurate and precise tunnel placement compared with conventional Surgery. Methods: In a prospective, double-blind, randomized clinical study, 100 patients eligible for ACL reconstruction with a transtibial technique were stratified by surgeon and randomized to either conventional or Computer-Assisted Surgery. Measurement of femoral and tibial tunnel placement with use of three-dimensional computed tomography (CT) was used as the primary outcome to compare conventional ACL Surgery with Computer-Assisted Surgery. Results: The placement of the femoral tunnel did not differ between groups (mean, 39.7% of the proximal-distal distance ontheintracondylar axis[Blumensaatline]intheconventional groupcomparedwith39.0%intheComputer-AssistedSurgery group; p = 0.70). The anterior-posterior positioning of the tibial tunnel on the tibial plateau also did not differ significantly (38.9% in the conventional group compared with 38.2% in the Computer-Assisted Surgery group; p = 0.58). There was no significant difference in the precision of either the femoral or the tibial tunnel placement between the two groups. Conclusions: There was no significant difference in either the accuracy or the precision of tunnel placement between conventional and Computer-Assisted ACL reconstruction. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  • Computer Assisted Surgery for knee ligament reconstruction protocol
    Cochrane Database of Systematic Reviews, 2009
    Co-Authors: Duncan E Meuffels, Max Reijman, Jan A N Verhaar
    Abstract:

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of Computer Assisted reconstruction Surgery versus conventional operating techniques for ACL or PCL deficient knees in adults. We will test these effects according to the following specific subgroups: 1. System used for CAS (e.g. per-operative use of X-rays, pre-operative use of radiology (CT, MRI, X-rays), per-operative landmarks or bone morphing). 2. Type of ligament reconstruction: ACL or PCL, or both.

Tsanwen Huang - One of the best experts on this subject based on the ideXlab platform.

  • differences in component and limb alignment between Computer Assisted and conventional Surgery total knee arthroplasty
    Knee Surgery Sports Traumatology Arthroscopy, 2014
    Co-Authors: Tsanwen Huang, Kuoti Peng, Robert Wenwei Hsu, Kuochin Huang, Mel S Lee
    Abstract:

    Purpose Marked coronal femoral bowing may bear a risk for mal-alignment of femoral component and reconstructed mechanical axis (MA) by using conventional instrumentations. The aim of this study was to investigate the usefulness of Computer-Assisted Surgery–total knee arthroplasty (CAS-TKA) under this circumstance.

  • total knee arthroplasty with use of Computer Assisted navigation compared with conventional guiding systems in the same patient radiographic results in asian patients
    Journal of Bone and Joint Surgery American Volume, 2011
    Co-Authors: Tsanwen Huang, Weihsiu Hsu, Kuoti Peng, Robert Wenwei Hsu, Yijan Weng, Wunjer Shen
    Abstract:

    Background: The value of Computer-Assisted Surgery in total knee arthroplasty for arthritic knees continues to be debated. We hypothesized that the usefulness of Computer assistance is related to the magnitude of the deviation from the preoperative mechanical axis and that Computer-Assisted Surgery may be beneficial under certain circumstances. Methods: Patients with bilateral knee osteoarthritis and genu varus deformity who were to have staged bilateral total knee arthroplasty were enrolled. The patients randomly underwent Computer-Assisted total knee arthroplasty in one knee and conventional total knee arthroplasty in the contralateral knee. The two methods were compared for accuracy of placement of the components and lower extremity alignment after total knee arthroplasty as determined by six radiographic parameters. Results: One hundred and thirteen patients (226 knees) met the inclusion criteria. For patients with a preoperative mechanical axis deviation of 20°, the reconstructed mechanical axes were significantly closer to normal in the Computer-Assisted total knee arthroplasty group. Significant results were also noted in the anatomical axes, femoral valgus angle, and femoral flexion angle. Furthermore, a higher percentage of knees in which Computer-Assisted Surgery was used had restoration of the mechanical axis within 3° of neutral. Conclusions: Computer-Assisted Surgery was a valuable adjunct for obtaining proper alignment during total knee arthroplasty in patients with knee osteoarthritis with severe varus deformity. Conventional total knee arthroplasty was as effective as Computer-Assisted total knee arthroplasty for obtaining proper alignment in patients with a minor to moderate deformity. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

William P Barrett - One of the best experts on this subject based on the ideXlab platform.