Comment: The quality of evidence is downgraded by limitations in study quality (poor reporting of trial methods), by inconsistency (heterogeneity in interventions and outcomes)and byimprecise results (limited study size for each comparison).
A Cochrane review [Abstract] 1 on computer assisted surgery (CAS) for anterior cruciate ligament (ACL) reconstruction included 5 studies with a total of 366 subjects. There were more female than male participants (70% were female); their ages ranged from 14 to 53 years. There was 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).
There was 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. Low quality evidence was found (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). 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.
All studies were performed by ACL surgeons or surgical groups with ample experience in reconstructive procedures. This may have left less room for improvement from the uses of CAS.
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