In this paper a new navigation system, KIN-Nav, developed for research and used during 80 anterior cruciate ligament (ACL) reconstructions is described. KIN-Nav is a user-friendly navigation system for flexible intraoperative acquisitions of anatomical and kinematic data, suitable for validation of biomechanical hypotheses. It performs real-time quantitative evaluation of antero-posterior, internal-external, and varus-valgus knee laxity at any degree of flexion and provides a new interface for this task, suitable also for comparison of pre-operative and post-operative knee laxity and surgical documentation. In this paper the concept and features of KIN-Nav, which represents a new approach to navigation and allows the investigation of new quantitative measurements in ACL reconstruction, are described. Two clinical studies are reported, as examples of clinical potentiality and correct use of this methodology. In this paper a preliminary analysis of KIN-Nav's reliability and clinical efficacy, performed during blinded repeated measures by three independent examiners, is also given. This analysis is the first assessment of the potential of navigation systems for evaluating knee kinematics.
GuardamagnaL.SeedhomB. B.OstellA. E.Double-band reconstruction of the ACL using a synthetic implant: A cadaveric study of knee laxityJ. Orthop. Sci., 2004, 9 (4), 372–379.
IshibashiY.TsudaE.TazawaK.SatoH.TohS.Intraoperative evaluation of the anatomical double-bundle anterior cruciate ligament reconstruction with the OrthoPilot navigation systemOrthopedics, 2005, 28 (10 Suppl.), 1277–1282.
7.
BullA. M.EarnshawP. H.SmithA.KatchburianM. V.HassanA. N.A.AmisA. A.Intraoperative measurement of the knee kinematics in reconstruction of the anterior cruciate ligamentJ. Bone Jt Surg. Br., 2002, 84, 1075–1081.
8.
KooS. S.AminianA.LeonardJ.KohJ.Use of a computerized optical tracking system to evaluate rotational and translational laxity pre- and post- anterior cruciate ligament reconstruction. In Proceedings of the Sixth Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery (CAOS-International 2006), (Montreal, Canada, 21–24 June 2006, pp. 543–545 (Pro Business, Berlin).
9.
ColombetP.AllardM.GranchiC.PlaskosC.LavalleeS.Anterior cruciate ligament reconstruction using knee joint laxity measurements and a bend-able model. In Proceedings of the Fifth Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery (CAOS-International 2005), (Helsinki, Finland, 19–21 June 2005, pp. 63–71 (Pro Business, Berlin).
10.
KlosT. VHarmanM. K.HabetsR. J.DevileeR. J.BanksS. A.Locating femoral graft placement from lateral radiographs in anterior cruciate ligament reconstruction: A comparison of 3 methods of measuring radiographic imagesArthroscopy, 2000, 16 (5), 499–504.
MartelliS.LopomoN.GreggioS.FerrettiE.VisaniA.Development and applications of a software tool for diarthrodial joint analysisComputer Meth. Programs Biomedicine, 2006, 83 (1), 50–56.
14.
ZaffagniniS.BignozziS.MartelliS.ImakiireN.LopomoN.MarcacciM.New intraoperative protocol for kinematic evaluation of ACL reconstruction: Preliminary resultsKnee Surg. Sports Traumatology Arthrosc., 2006, 14 (9), 811–816.
15.
MartelliS.ZaffagniniS.BignozziS.BontempiM.MarcacciM.Validation of a new protocol for computer-assisted evaluation of kinematics of double-bundle ACL reconstructionClin. Biomechanics, 2006, 21 (3), 279–287.
16.
MartelliS.ZaffagniniS.Computerized protocol for anatomical and functional studies of jointsMeth. Molecular Medicine, 2004, 101, 319–338.
17.
ZaffagniniS.BignozziS.MartelliS.ImakiireN.MarcacciM.Kinematic analysis of two different tunnel orientations in double bundle ACL reconstruction. In Proceedings of the Fifth Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery (CAOS-International 2005), (Helsinki, Finland, 19–21 June 2005, pp. 527–529 (Pro Business, Berlin)
18.
MartelliS.LopomoN.BignozziN.ZaffagniniS.VisaniA.Validation of a new protocol for navigated intraoperative assessment of knee kinematicsComputers Biology Medicine, 2007, 37 (6), 872–878.
19.
WindhagenH.ThroeyF.OstermeierS.EmmerichJ.WirthC. J.Stukeborg-ColsmanC.Navigator concept. Optimizing the procedure for navigated total knee arthroplastyOrthopade, 2005, 4 (11), 1125–1130.
20.
GroodE. S.SuntayW. J.A joint coordinate system for the clinical description of three-dimensional motions: Application to the kneeJ. Biomech. Engng, 1983, 105 (2), 36–44.
21.
WuG.SieglerS.AllardP.KirtleyC.LeardiniA.RosenbaumD.WhittleM.D'LimaD.CristofoliniL.WitteH.SchmidO.StokesI.ISB recommendation on definition of joint coordinate system of various joints for the reporting of human joint motion - part I: Ankle, hip, and spineJ. Biomechanics, 35 (4), 543–548.
22.
WuG.CavanaghP. R.ISB recommendation for standardization in the reporting of kinematic dataJ. Biomechanics, 1995, 28 (10), 1257–1260.
MarcacciM.ZaffagniniS.IaconoF.NeriM. P.LoretiI.PetittoA.Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons, Knee Surg. Sports Traumatology Arthrosc., 1998, 6 (2), 68–75.
25.
ShoemakerS. C.MarkolfK. L.In vivo rotatory knee stabilityJ. Bone Jt Surg. Am., 1982, 64 (2), 208–216.
26.
FlemingB. C.BeynnonB. D.JohnsonR. J.The use of knee laxity testers for the determination of anterior-posterior stability of the knee: Pitfalls in practice In The anterior cruciate ligament: current and future concepts (Ed. JacksonD.), 1993, pp. 239–250 (Raven Press, New York).
27.
KärrholmJ.SelvikG.ElmqvistL. G.HanssonL. I.JonssonH.Three-dimensional instability of the anterior cruciate deficient kneeJ. Bone Jt Surg. Br., 1988, 70, 777–783.
28.
WrobleR. R.VanGinkelL. A.GroodE. S.NoyesF. R.ShafferB. L.Repeatability of the KT-1000 arthrometer in a normal populationAm. J. Sports Medicine, 1990, 18, 396–399.
29.
FlemingB. C.BrattbakkB.PeuraG. D.BadgerG. J.BeynnonB. D.Measurement of anterior-posterior knee laxity: A comparison of three techniquesJ. Orthop. Res., 2002, 20, 421–426.
30.
MuellnerT.BuggeW.JohansenS.HoltanC.EkgebretsenL.Inter and intratester comparison of the Rolimeter knee tester: Effect of tester's experience and the examination techniqueKnee Surg. Sports Traumatology Arthrosc., 2001, 9, 302–306.
