Abstract
PurposeThe purpose of this study was to investigate how different techniques of single-bundle anterior cruciate ligament (ACL) reconstruction affect subjective knee function via the Knee injury and Osteoarthritis Outcome Score (KOOS) evaluation 2 years after surgery. It was hypothesized that the surgical techniques of single-bundle ACL reconstruction would result in equivalent results with respect to subjective knee function 2 years after surgery.MethodsThis cohort study was based on data from the Swedish National Knee Ligament Register during the 10-year period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstrings tendon autograft were included. Details on surgical technique were collected using a web-based questionnaire comprised of essential AARSC items, including utilization of accessory medial portal drilling, anatomic tunnel placement, and visualization of insertion sites and landmarks. A repeated measures ANOVA and an additional linear mixed model analysis were used to investigate the effect of surgical technique on the KOOS4 from the pre-operative period to 2-year follow-up.ResultsA total of 13,636 patients who had undergone single-bundle ACL reconstruction comprised the study group for this analysis. A repeated measures ANOVA determined that mean subjective knee function differed between the pre-operative time period and at 2-year follow-up (p < 0.001). No differences were found with respect to the interaction between KOOS4 and surgical technique or gender. Additionally, the linear mixed model adjusted for age at reconstruction, gender, and concomitant injuries showed no difference between surgical techniques in KOOS4 improvement from baseline to 2-year follow-up. However, KOOS4 improved significantly in patients for all surgical techniques of single-bundle ACL reconstruction (p < 0.001); the largest improvement was seen between the pre-operative time period and at 1-year follow-up.ConclusionSurgical techniques of primary single-bundle ACL reconstruction did not demonstrate differences in the improvement in baseline subjective knee function as measured with the KOOS4 during the first 2 years after surgery. However, subjective knee function improved from pre-operative baseline to 2-year follow-up independently of surgical technique.
Highlights
Optimizing long-term outcomes after anterior cruciate ligament (ACL) injury remains a challenge for both physicians and physical therapists
A total of 2843 patients (1520 women and 1323 men) who had undergone single-bundle ACL reconstruction were included in the repeated measure analysis of KOOS4 from the pre-operative time point to follow-up at 2 years
A repeated measures ANOVA determined that no differences were found for the interaction between subjective knee function, KOOS4, and surgical techniques (Fig. 2)
Summary
Optimizing long-term outcomes after anterior cruciate ligament (ACL) injury remains a challenge for both physicians and physical therapists. Over the last several decades, the surgical techniques for single-bundle ACL reconstruction have evolved and the traditional transtibial drilling technique has recently come under scrutiny In this regard, it has been shown that transtibial drilling has the tendency to result in a non-anatomic reconstruction when evaluated in reference to the native ACL footprints [20, 34]. Several studies have suggested that grafts placed anatomically are exposed to greater (i.e. native) in situ forces as opposed to those placed non-anatomically [3, 23, 35] In this regard, a study from the Danish Knee Ligament Reconstruction Register reported an increased risk of revision ACL surgery when a transportal technique was compared to reconstructions performed using a transtibial technique [28]. Most studies only investigate single surgical factors in a limited cohort
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