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Klein B, Bartlett LE, Huyke-Hernandez FA, Tauro TM, Landman F, Cohn RM, Sgaglione NA. Analysis of Changing Practice Trends in Anterior Cruciate Ligament Reconstruction: A Multicenter, Single-Institution Database Analysis. Arthroscopy 2024:S0749-8063(24)00169-5. [PMID: 38447628 DOI: 10.1016/j.arthro.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To identify trends in anterior cruciate ligament reconstruction (ACLR), including graft choice, femoral tunnel drilling techniques, and augmentation techniques, and to assess how various surgeon factors impact these trends. METHODS A retrospective review of primary ACLRs performed between 2014 and 2022 was completed using a multicenter institutional database. Patient demographic characteristics, graft type, femoral drilling technique, use of extra-articular tenodesis, and use of suture augmentation were recorded from the medical record. Surgeon fellowship training (sports trained vs non-sports trained), experience (high [minimum of 15 years in practice] vs low), and volume (high [minimum of 15 ACLRs/year] vs low) were used to stratify technique utilization. The z test for proportions was used to compare categorical variables. Pearson correlation analyses identified trends and assessed statistical significance, defined as P < .05. RESULTS Our cohort consisted of 2,032 ACLRs performed in 2,006 patients. The average patient age was 28.3 ± 11.6 years, with more procedures performed in male patients (67.3%). The average length of surgeon experience was 19.7 ± 11.4 years, with an average annual procedural volume of 4.0 ± 5.4 ACLRs. Most surgeons were sports trained (n = 55, 64.7%), high experience (n = 44, 57.1%), and low volume (n = 80, 94.1%). There was an increasing annual proportion of ACLRs performed by sports-trained surgeons (R = 0.748, P = .020) and low-experience surgeons (R = 0.940, P < .001). Autograft reconstructions were most often performed by sports-trained (71.2%), low-experience (66.1%), and high-volume (76.9%) surgeons. There was an increasing proportion of autograft ACLRs that used quadriceps tendon among sports-trained (R = 0.739, P = .023), high-experience (R = 0.768, P = .016), and low-volume (R = 0.785, P = .012) surgeons. Independent drilling techniques were used in an increasing proportion of ACLRs performed by non-sports-trained (R = 0.860, P = .003) and high-volume (R = 0.864, P = .003) surgeons. Augmentation of ACLR with concomitant suture augmentation (n = 24, 1.2%) or extra-articular tenodesis (n = 6, 0.3%) was rarely performed. CONCLUSIONS In our multicenter institution, the quadriceps tendon autograft has been increasingly used in ACLR by sports-trained, low-volume, and high-experience surgeons. Independent drilling techniques have been increasingly used by non-sports-trained and high-volume surgeons. CLINICAL RELEVANCE Surgeons must stay current with the literature that affects their procedures to ensure that evidence-based medicine is being practiced.
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Affiliation(s)
- Brandon Klein
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Huntington, New York, U.S.A..
| | - Lucas E Bartlett
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | | | - Tracy M Tauro
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Francis Landman
- Mount Sinai South Nassau, Department of Internal Medicine, Oceanside, New York, U.S.A
| | - Randy M Cohn
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Huntington, New York, U.S.A
| | - Nicholas A Sgaglione
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Huntington, New York, U.S.A
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Anderson AB, Dekker TJ, Pav V, Mauntel TC, Provencher MT, Tokish JM, Volker M, Sansone M, Karlsson J, Dickens JF. Survival of anterior cruciate ligament reconstructions in active-duty military populations. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07335-w. [PMID: 36809509 DOI: 10.1007/s00167-023-07335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure. METHODS A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan-Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure. RESULTS Of the 2735 primary ACLRs included in the study, 484/2,735 (18%) experienced ACLR failure within four years, including (261/2,735) (10%) undergoing revision ACLR and (224/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87), > 180 days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044). CONCLUSION The overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ashley B Anderson
- Uniformed Services University-Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.
| | - Travis J Dekker
- Department of Orthopaedics, Eglin Air Force Base, Eglin, FL, USA
| | - Veronika Pav
- Kennell & Associates, Inc., Falls Church, VA, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy C Mauntel
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Fort Bragg, NC, USA
| | | | | | - Musahl Volker
- Medical Center Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Sansone
- Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden
| | - Jonathan F Dickens
- Uniformed Services University-Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA.,Department of Orthopaedics Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg University, Göteborg, Sweden.,Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.,John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, NY, USA.,Duke University Hospital Department of Orthopaedics, Durham, NC, USA
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Patzkowski JC, Dunn JC. Editorial Comment: Selected Proceedings From the Society of Military Orthopaedic Surgeons 2021 Annual Meeting. Clin Orthop Relat Res 2022; 480:2108-2110. [PMID: 36173767 PMCID: PMC9555938 DOI: 10.1097/corr.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jeanne C. Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
| | - John C. Dunn
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
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