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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-05-2017 | Knee

Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register

Authors: Neel Desai, Daniel Andernord, David Sundemo, Eduard Alentorn-Geli, Volker Musahl, Freddie Fu, Magnus Forssblad, Kristian Samuelsson

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2017

Abstract

Purpose

To investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register.

Methods

This cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an “anatomic” reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery.

Results

A total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490–0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548–1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718–1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047–1.640); P = 0.018].

Conclusion

Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery increased when using transportal drilling. Performing anatomic ACL reconstruction utilizing eight selected essential items from the AARSC lowered the risk of revision surgery associated with transportal drilling and anatomic bone tunnel placement. Detailed knowledge of surgical technique using the AARSC predicts the risk of ACL revision surgery.

Level of evidence

III.

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Title: Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register
Authors: Neel Desai
Daniel Andernord
David Sundemo
Eduard Alentorn-Geli
Volker Musahl
Freddie Fu
Magnus Forssblad
Kristian Samuelsson
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4399-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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