A Pilot Study on the Use of a Novel Mixed Reality Navigation System to Assist Femoral Tunnel Positioning in Single-Bundle Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is crucial for restoring knee joint stability, and its success rate is largely dependent on the precise positioning of the femoral tunnel. Traditional surgical methods rely on two-dimensional (2D) images, which are accompanied by low spatial resolution, lack of three-dimensional (3D) anatomical information, and poor visualization. Mixed reality (MR) technology, with its advantages of preoperative computed tomography (CT) reconstruction and anatomical position visualization, has shown substantial potential in enhancing surgical precision. This research designed a novel Mixed Reality Surgical Navigation System (MR-SNS) and evaluated its effectiveness in assisting femoral tunnel positioning in single-bundle ACL reconstruction. The results suggested that the MR group using MR-SNS demonstrated higher femoral tunnel positioning precision (F <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$0.22\pm 0.16,0.66\pm 0.27$</tex>), notably superior to the conventional group (<tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$2.57\pm 0.30$</tex> and <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$2.07\pm 0.34$</tex>). MR also displayed positive effects in reducing the cognitive load on surgeons. This study supports the application of MR-SNS in orthopaedic surgery, providing scientific evidence for the development of MR in surgical navigation. With technological advancements and cost reductions, MR-SNS is expected to become an indispensable tool for orthopaedic surgeons in achieving precise surgeries.