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

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

Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament.

PURPOSE Failure of dynamic intraligamentary stabilization (DIS) that requires revision surgery of the anterior cruciate ligament (ACL) has not been studied. The aim of this study was to investigate the incidence of revision ACL surgery, and the patient characteristics and surgery-related factors that are associated with an increased risk of ACL revision after DIS. METHODS This study analysed a prospective, consecutively documented single-centre case series using standardized case report forms over a 2.5-year follow-up period. The primary endpoint was revision ACL surgery. We used Kaplan-Meier analysis to examine the revision-free survival time, and a multiple logistic regression model of potential risk factors including age, sex, BMI, smoking status, previous contralateral ACL injury, Tegner activity score, interval to surgery, rupture pattern, hardware removal, and postoperative side-to-side difference in knee laxity. Relative risk was calculated for subgroups of significant risk factors. RESULTS In total, 381 patients (195 male) with a mean age of 33 ± 12 years were included in the analysis. The incidence of revision ACL surgery was 30/381 (7.9%). Younger age (p = 0.001), higher Tegner activity score (p = 0.003), and increased knee laxity (p = 0.015) were significantly associated with revision ACL surgery. The increased relative risk for patients who were less than 24 years old, participated in activities at a Tegner level >5 points, or had >2 mm of side-to-side difference in knee laxity was 1.6, 3.7, and 2.3, respectively. CONCLUSION Young age, high level of sport activity, and high knee laxity observed in follow-up examinations increased the likelihood for revision surgery after DIS. Patients undergoing DIS should be informed of their potentially increased risk for therapy failure and carefully monitored during recovery. LEVEL OF EVIDENCE Case series, Level IV

Correction to: Patient and surgical characteristics that affect revision risk in dynamic intraligamentary stabilization of the anterior cruciate ligament [correction].

The original version of this article unfortunately contained a mistake