Computer-assisted anatomical placement of a double-bundle ACL through 3D-fitting of a statistically generated femoral template into individual knee geometry

Femoral graft placement is an important factor in the success of ACL-reconstruction. Besides improving the accuracy of femoral tunnel placement, Computer Assisted Surgery (CAS) can be used to determine the anatomical Location. This requires a 3D femoral template with the position of the anatomical ACL-center, based on endoscopical measurable landmarks. This study describes the development and application of this method. The template is generated through statistical shape analysis of the ACL-insertion, with respect to the anteromedial- (AMB) and posterolateral bundle (PLB). The data is mapped onto a cylinder and related to the intercondylar notch surface and the cartilage border on the lateral notch wall (n=33). The template was programmed in a computer-assisted system for ACL-replacement and validated. The program allows real-time tracking of the femur and interactive digitization under endoscopic control. In a wizard-like fashion the surgeon is guided through steps of acquiring the landmarks for the template alignment. The AMB-and PLB-center are accurate positioned within 1-3 mm of the anatomic insertion-centers in individual knees