Femoral Tunnel Drilling Method: Risk of Reoperation and Revision After Anterior Cruciate Ligament Reconstruction

被引:23
作者
Tejwani, Samir G. [1 ,2 ]
Prentice, Heather A. [1 ,3 ]
Wyatt, Ronald W. B., Jr. [1 ,4 ]
Maletis, Gregory B. [1 ,5 ]
机构
[1] Kaiser Permanente, Surg Outcomes & Anal Dept, San Diego, CA USA
[2] Southern Calif Permanente Med Grp, Dept Orthopaed, Fontana, CA USA
[3] Southern Calif Permanente Med Grp, Surg Outcomes & Anal, San Diego, CA 92120 USA
[4] Permanente Med Grp Inc, Dept Orthopaed, Walnut Creek, CA USA
[5] Southern Calif Permanente Med Grp, Dept Orthopaed, Baldwin Pk, CA USA
关键词
ACL; reconstruction; revision; reoperation; femoral tunnel; drilling method; KNEE; SINGLE; SURGERY; PREDICTORS; PLACEMENT; ALLOGRAFT; POSITION; FORCE;
D O I
10.1177/0363546518805086
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The femoral tunnel in anterior cruciate ligament reconstruction (ACLR) can be created by the transtibial (TT) or tibial-independent (TI) methods. An anatomically located femoral tunnel can be more consistently achieved by TI methods, which include the anteromedial portal and lateral (outside-in, retrodrill) techniques. Nonanatomic graft placement in ACLR can result in postoperative instability and meniscal or chondral injury. An anatomically located graft is subjected to higher postoperative physiologic forces than one placed nonanatomically. Purpose: To examine isolated primary ACLR and determine the risk of aseptic revision and reoperation based on femoral tunnel drilling method. Study Design: Cohort study; Level of evidence, 2. Methods: The ACLR registry of an integrated US health care system was used to identify primary isolated unilateral ACLRs from 2009 to 2014. Multivariable Cox proportional hazard regression models were used to evaluate risk for aseptic revision for graft failure and aseptic reoperation for meniscal or chondral injury according to femoral tunnel drilling method: TI versus TT. Models included age, sex, body mass index (BMI), race, graft type, and femoral fixation type as covariates. Results: The cohort included 19,059 patients with primary ACLR. The mean age was 28.9 years (SD, 11.5), 6991 patients (36.8%) were younger than 22 years, 11,795 patients (61.9%) were male, 7648 patients (40.1%) had a BMI less than 25 kg/m(2), 8913 patients (46.8%) were white, and 7357 patients (38.6%) received an allograft. Median follow-up was 2.30 years (interquartile range, 1.08-3.77). TI techniques were used for 12,342 (64.8%) of the ACLRs, and the TT method was used for 6717 (35.2%). Use of TI techniques increased from 33.6% of all ACLRs in 2009 to 83.4% in 2014. After adjustment for covariates, the TI group had a higher risk for aseptic revision than the TT group (hazard ratio [HR], 1.28; 95% CI, 1.04-1.56), and this risk was 1.41 times higher in patients younger than 22 years specifically. The 5-year cumulative reoperation probability was lower in the TI group (4.50%; 95% CI, 3.78%-5.36%) compared with the TT group (5.06%; 95% CI, 4.31-5.94%). After adjustment for the covariates, no difference in risk for aseptic reoperation was observed (HR, 1.08; 95% CI, 0.85-1.39). Conclusion: In the largest known study of its type examining femoral tunnel drilling method for primary ACLR, after adjustment for age, sex, BMI, race, graft type, and femoral fixation, TI techniques were found to carry higher risk of aseptic revision compared with the TT method, while no difference was observed in risk for aseptic reoperation.
引用
收藏
页码:3378 / 3384
页数:7
相关论文
共 36 条
[1]   ACL Graft Position Affects in Situ Graft Force Following ACL Reconstruction [J].
Araujo, Paulo H. ;
Asai, Shigehiro ;
Pinto, Mauricio ;
Protta, Thiago ;
Middleton, Kellie ;
Linde-Rosen, Monica ;
Irrgang, James ;
Smolinski, Patrick ;
Fu, Freddie H. .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2015, 97A (21) :1767-1773
[2]   Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction? [J].
Chhadia, Ankur M. ;
Inacio, Maria C. S. ;
Maletis, Gregory B. ;
Csintalan, Rick P. ;
Davis, Brent R. ;
Funahashi, Tadashi T. .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2011, 39 (09) :1894-1899
[3]   Risk Factors of Subsequent Operations After Primary Anterior Cruciate Ligament Reconstruction [J].
Csintalan, Rick P. ;
Inacio, Maria C. S. ;
Funahashi, Tadashi T. ;
Maletis, Gregory B. .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2014, 42 (03) :619-625
[4]   The Incidence of Subsequent Meniscal Surgery Is Higher in the Anterior Cruciate Ligament-Reconstructed Knee Than in the Contralateral Knee [J].
Davis, Brent R. ;
Chen, Jason ;
Inacio, Maria C. S. ;
Love, Rebecca ;
Prentice, Heather A. ;
Maletis, Gregory B. .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2017, 45 (14) :3216-3222
[5]   The Influence of Knee Flexion Angle for Graft Fixation on Rotational Knee Stability During Anterior Cruciate Ligament Reconstruction: A Biomechanical Study [J].
Debandi, Anibal ;
Maeyama, Akira ;
Hoshino, Yuichi ;
Asai, Shigehiro ;
Goto, Bunsei ;
Smolinski, Patrick ;
Fu, Freddie H. .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2016, 32 (11) :2322-2328
[6]   Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register [J].
Desai, Neel ;
Andernord, Daniel ;
Sundemo, David ;
Alentorn-Geli, Eduard ;
Musahl, Volker ;
Fu, Freddie ;
Forssblad, Magnus ;
Samuelsson, Kristian .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2017, 25 (05) :1542-1554
[7]  
Duffee A, 2013, J BONE JOINT SURG AM, V95A, P2035, DOI [10.2106/JBJS.L.00187, 10.2106/JBJS.M.00187]
[8]   Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models [J].
Ghali, WA ;
Quan, HD ;
Brant, R ;
van Melle, G ;
Norris, CM ;
Faris, PD ;
Galbraith, PD ;
Knudtson, ML .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (12) :1494-1497
[9]   ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics [J].
Herbort, Mirco ;
Lenschow, Simon ;
Fu, Freddie H. ;
Petersen, Wolf ;
Zantop, Thore .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2010, 18 (11) :1551-1558
[10]   Can Joint Contact Dynamics Be Restored by Anterior Cruciate Ligament Reconstruction? [J].
Hoshino, Yuichi ;
Fu, Freddie H. ;
Irrgang, James J. ;
Tashman, Scott .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2013, 471 (09) :2924-2931