Surgical variables at the time of revision anterior cruciate ligament (ACL) reconstruction influence patient outcomes at six years, according to a study presented at the combined annual meeting of the American Orthopedic Society for Sports Medicine and the Arthroscopy Association of North America, held from July 7 to 11 in Nashville, Tennessee.
Rick Wright, MD, from the Vanderbilt University Medical Center in Nashville, and colleagues followed revision ACL reconstruction patients for six years to examine whether surgical factors influence outcome. A total of 1,234 patients were enrolled; follow-up was obtained on 77 percent of patients at six years.
The researchers found that several surgical factors were significant drivers of poorer outcomes at six years, with the most consistent surgical variables driving outcomes related to femoral and tibial fixation. Use of an interference screw versus a cross-pin for femoral fixation was associated with significantly better outcomes in the six-year International Knee Documentation Committee (IKDC) score (odds ratio, 2.2) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation and KOOS Quality of Life subscales (odds ratio range, 2.2 to 2.7), as well as a 2.6-fold lower likelihood of subsequent surgery within six years. Compared with any combination of tibial fixation techniques, use of an interference screw for tibial fixation was associated with significantly better outcomes in IKDC score (odds ratio, 2.0) and three KOOS subscales (odds ratio range, 1.5 to 1.6).
“Opting for a transtibial surgical approach and choosing an [interference] screw for femoral and tibial fixation, will improve the patient’s odds of having a significantly better six-year clinical outcome,” Wright said in a statement.
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