Philipp Henle1, Kathrin S Bieri2, Janosch Haeberli1, Nele Arnout3, Jan Victor3, Mirco Herbort4, Clemens Koesters4, Stefan Eggli1. 1. Department of Knee Surgery and Sports Traumatology, Sonnenhof Orthopaedic Center, Bern, Switzerland. 2. Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland. kathrin.bieri@ispm.unibe.ch. 3. Ghent University Hospital, Ghent, Belgium. 4. University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.
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.
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.
Authors: Samir G Tejwani; Jason Chen; Tadashi T Funahashi; Rebecca Love; Gregory B Maletis Journal: Am J Sports Med Date: 2015-06-11 Impact factor: 6.202
Authors: Daniel Andernord; Neel Desai; Haukur Björnsson; Mattias Ylander; Jón Karlsson; Kristian Samuelsson Journal: Am J Sports Med Date: 2014-10-16 Impact factor: 6.202
Authors: Warren R Dunn; Stephen Lyman; Andrew E Lincoln; Paul J Amoroso; Thomas Wickiewicz; Robert G Marx Journal: Am J Sports Med Date: 2004-12 Impact factor: 6.202
Authors: Johannes Glasbrenner; Michael J Raschke; Christoph Kittl; Elmar Herbst; Christian Peez; Thorben Briese; Philipp A Michel; Mirco Herbort; Clemens Kösters; Benedikt Schliemann Journal: Am J Sports Med Date: 2022-08-25 Impact factor: 7.010