Augmented reality-based surgical guidance for wrist arthroscopy with bone-shift compensation

The role of navigation technology in anterior cruciate ligament reconstruction bone tunnel positioning

In the past decade, navigation technology-assisted bone tunnels positioning for anterior cruciate ligament reconstruction (ACLR) has received great attention. The purpose of this review is to summarize the navigation technologies applied in ACLR, describe the tunnel positioning accuracy of these technologies, and summarize their advantages and disadvantages, providing a basis for navigation technology to assist ACLR. This review discusses the limitations of traditional bone tunnel positioning methods in ACLR and further introduces various navigation techniques, focusing on their positioning accuracy and postoperative outcomes for patients. Additionally, it presents commercial systems utilizing reality-based technologies and examines their impact on the arthroscopic learning curve for less experienced surgeons. The osseous landmarks are currently the most used positioning method, but they still have shortcomings. Navigation technologies primarily focus on computer-assisted navigation, which, however, requires additional incisions. Virtual reality and augmented reality are mainly utilized in preoperative planning, with the best-reported positioning accuracy of augmented reality being 0.32 mm, while most other accuracies are within 3 mm. Mixed reality offers a novel approach for precise positioning, resulting in more optimal and consistent postoperative tunnel placement. Navigation technology improves the positioning accuracy of the bone tunnels and achieves good short-term results. Key to the future is long-term follow-up to assess clinical outcomes of navigation techniques.

Seamless augmented reality integration in arthroscopy: a pipeline for articular reconstruction and guidance

Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat joint problems. The clinical workflow of arthroscopy typically involves inserting an arthroscope into the joint through a small incision, during which surgeons navigate and operate largely by relying on their visual assessment through the arthroscope. However, the arthroscope's restricted field of view and lack of depth perception pose challenges in navigating complex articular structures and achieving surgical precision during procedures. Aiming at enhancing intraoperative awareness, a robust pipeline that incorporates simultaneous localization and mapping, depth estimation, and 3D Gaussian splatting (3D GS) is presented to realistically reconstruct intra-articular structures solely based on monocular arthroscope video. Extending 3D reconstruction to augmented reality (AR) applications, the solution offers AR assistance for articular notch measurement and annotation anchoring in a human-in-the-loop manner. Compared to traditional structure-from-motion and neural radiance field-based methods, the pipeline achieves dense 3D reconstruction and competitive rendering fidelity with explicit 3D representation in 7 min on average. When evaluated on four phantom datasets, our method achieves root-mean-square-error(RMSE) = 2.21 mm reconstruction error, peak signal-to-noise ratio(PSNR) = 32.86 and structure similarity index measure(SSIM) = 0.89 on average. Because the pipeline enables AR reconstruction and guidance directly from monocular arthroscopy without any additional data and/or hardware, the solution may hold the potential for enhancing intraoperative awareness and facilitating surgical precision in arthroscopy. The AR measurement tool achieves accuracy within1.59 ± 1.81 mm and the AR annotation tool achieves a mIoU of 0.721.

The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery

Extended reality (XR) technology refers to any situation where real-world objects are enhanced with computer technology, including virtual reality, augmented reality, and mixed reality. Augmented reality and mixed reality technologies have been widely applied in orthopedic clinical practice, including in teaching, preoperative planning, intraoperative navigation, and surgical outcome evaluation. The primary goal of this narrative review is to summarize the effectiveness and superiority of XR-technology-assisted intraoperative navigation in the fields of trauma, joint, spine, and bone tumor surgery, as well as to discuss the current shortcomings in intraoperative navigation applications. We reviewed titles of more than 200 studies obtained from PubMed with the following search terms: extended reality, mixed reality, augmented reality, virtual reality, intraoperative navigation, and orthopedic surgery; of those 200 studies, 69 related papers were selected for abstract review. Finally, the full text of 55 studies was analyzed and reviewed. They were classified into four groups-trauma, joint, spine, and bone tumor surgery-according to their content. Most of studies that we reviewed showed that XR-technology-assisted intraoperative navigation can effectively improve the accuracy of implant placement, such as that of screws and prostheses, reduce postoperative complications caused by inaccurate implantation, facilitate the achievement of tumor-free surgical margins, shorten the surgical duration, reduce radiation exposure for patients and surgeons, minimize further damage caused by the need for visual exposure during surgery, and provide richer and more efficient intraoperative communication, thereby facilitating academic exchange, medical assistance, and the implementation of remote healthcare.

Application progress of artificial intelligence and augmented reality in orthopaedic arthroscopy surgery

In today's rapidly developing technological era, the technological revolution triggered by the rapid iteration of artificial intelligence and augmented reality has provided brand-new digital intelligent empowerment for orthopaedic clinical operation. Although traditional arthroscopy has been widely promoted globally due to its advantages such as minimally invasive, safety and early functional exercise, it still has deficiencies in precision and personalization. The assistance of artificial intelligence and augmented reality enables precise positioning and navigation in arthroscopic surgery, as well as personalized operations based on patient conditions, which lifts the objective limitations of traditional sports medicine surgery. The integration of artificial intelligence and augmented reality with orthopaedic arthroscopy surgery is still in infancy, even though there are still some insufficient to be solved, but its prospect is bright.