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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2018

01-10-2018 | Knee

Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure

Authors: Philipp Henle, Kathrin S. Bieri, Janosch Haeberli, Nele Arnout, Jan Victor, Mirco Herbort, Clemens Koesters, Stefan Eggli

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2018

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Abstract

Purpose

Studies on dynamic intraligamentary stabilization (DIS) of acute anterior cruciate ligament (ACL) ruptures reported failure rates similar to those of conventional ACL reconstruction. This study aimed to determine whether surgeon experience with DIS is associated with revision rates or patient-reported outcomes. The hypothesis was that more experienced surgeons achieved better outcomes following DIS due to substantial learning curve.

Methods

The authors prospectively enrolled 110 consecutive patients that underwent DIS and evaluated them at a minimum of 2 years. The effects of independent variables (surgeon experience, gender, age, adjuvant procedures, tear location, preinjury Tegner score, time from injury to surgery, and follow-up) on four principal outcomes (revision ACL surgery, any re-operation, IKDC and Lysholm score) were analyzed using univariable and multivariable regressions.

Results

From the 110 patients enrolled, 14 patients (13%) were lost to follow-up. Of the remaining 96 patients, 11 underwent revision ACL surgery, leaving 85 patients for clinical assessment at a mean of 2.2 ± 0.4 years (range 2.0–3.8). Arthroscopic reoperations were performed in 26 (27%) patients, including 11 (11%) revision ACL surgeries. Multivariable regressions revealed: (1) no associations between the reoperation rate and the independent variables, (2) better IKDC scores for ‘designer surgeons’ (b = 10.7; CI 4.9–16.5; p < 0.001), higher preinjury Tegner scores (b = 2.5, CI 0.8–4.2; p = 0.005), and younger patients (b = 0.3, CI 0.0–0.6; p = 0.039), and (3) better Lysholm scores for ‘designer surgeons’ (b = 7.8, CI 2.8–12.8; p = 0.005) and preinjury Tegner score (b = 1.9, CI 0.5–3.4; p = 0.010).

Conclusion

Surgeon experience with DIS was not associated with rates of revision ACL surgery or general re-operations. Future, larger-scaled studies are needed to confirm these findings. Patients operated by ‘designer surgeons’ had slightly better IKDC and Lysholm scores, which could be due to better patient selection and/or positively biased attitudes of both surgeons and patients.

Level of evidence

Level II, prospective comparative study.
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Metadata
Title
Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure
Authors
Philipp Henle
Kathrin S. Bieri
Janosch Haeberli
Nele Arnout
Jan Victor
Mirco Herbort
Clemens Koesters
Stefan Eggli
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4847-0

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