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Transtibial ACL Femoral Tunnel Preparation Increases Odds of Repeat Ipsilateral Knee Surgery

Duffee, Andrew MD; Magnussen, Robert A. MD; Pedroza, Angela D. MPH; Flanigan, David C. MD; MOON Group; Kaeding, Christopher C. MD

Journal of Bone & Joint Surgery - American Volume: 20 November 2013 - Volume 95 - Issue 22 - p 2035–2042
doi: 10.2106/JBJS.M.00187
Scientific Articles

This article was updated on January 13, 2015, because one of the members of the MOON Group (Warren R. Dunn, MD, MPH) was not listed in the footnote. The footnote now reads: “*MOON contributing authors: Kurt P. Spindler, MD, and Laura J. Huston, MS (Vanderbilt University School of Medicine); Rick W. Wright, MD, Matthew J. Matava, MD, and Robert H. Brophy, MD (Washington University School of Medicine at Barnes-Jewish Hospital); Eric C. McCarty, MD (University of Colorado School of Medicine); Robert G. Marx, MD, MSc (Hospital for Special Surgery); Richard D. Parker, MD, Jack T. Andrish, MD, and Morgan H. Jones, MD, MPH (Cleveland Clinic); Annunziato Amendola, MD, and Brian R. Wolf, MD, MS (University of Iowa); James L. Carey, MD, MPH (University of Pennsylvania); and Warren R. Dunn, MD, MPH (University of Wisconsin).”

An erratum has been published: J Bone Joint Surg Am 2015; 97(4); e21.

Background: Recent efforts to improve the results of anterior cruciate ligament (ACL) reconstruction have focused on placing the femoral tunnel anatomically. Medial portal femoral tunnel techniques facilitate drilling of femoral tunnels that are more anatomic than those made with transtibial techniques. Few studies have compared the clinical outcomes of these two femoral tunnel techniques. We hypothesized that the transtibial technique is associated with decreased Knee injury and Osteoarthritis Outcome Scores (KOOS) and an increased risk of repeat surgery in the ipsilateral knee when compared with the anteromedial portal technique.

Methods: Four hundred and thirty-six patients who had undergone primary isolated autograft ACL reconstruction with a transtibial (229 patients) or anteromedial portal (207 patients) technique in 2002 or 2003 were identified in a prospective multicenter cohort. A multiple linear regression model was used to determine whether surgical technique (transtibial or anteromedial portal) was a significant predictor of KOOS at six years postoperatively, after controlling for preoperative KOOS, patient age, sex, activity level, body mass index (BMI), smoking status, graft type, and the presence of meniscal and chondral pathology at the time of reconstruction. A multiple logistic regression model was used to determine whether surgical technique was a significant predictor of repeat ipsilateral knee surgery, after controlling for patient age and activity level, graft type, and meniscal pathology at the time of reconstruction.

Results: Postoperative KOOS were available for 387 patients (88.8%). Femoral tunnel drilling technique was not a predictor of the KOOS Quality of Life subscore (p = 0.72) or KOOS Function, Sports and Recreational Activities subscore (p = 0.36) at the six-year follow-up evaluation. Data regarding the prevalence of repeat surgery were available for 380 patients. Femoral tunnel technique was a significant predictor of subsequent ipsilateral knee surgery (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.30 to 4.78, p = 0.006).

Conclusions: Patients who underwent ACL reconstruction with a transtibial technique had significantly higher odds of undergoing repeat ipsilateral knee surgery relative to those who underwent reconstruction with an anteromedial portal technique.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Shelbyville Orthopaedics and Sports Medicine, 101 Stonecrest, #2, Shelbyville, KY 40065

2Department of Orthopaedic Surgery, OSU Sports Medicine, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221. E-mail address for R.A. Magnussen: robert.magnussen@gmail.com

* MOON contributing authors: Kurt P. Spindler, MD, and Laura J. Huston, MS (Vanderbilt University School of Medicine); Rick W. Wright, MD, Matthew J. Matava, MD, and Robert H. Brophy, MD (Washington University School of Medicine at Barnes-Jewish Hospital); Eric C. McCarty, MD (University of Colorado School of Medicine); Robert G. Marx, MD, MSc (Hospital for Special Surgery); Richard D. Parker, MD, Jack T. Andrish, MD, and Morgan H. Jones, MD, MPH (Cleveland Clinic); Annunziato Amendola, MD, and Brian R. Wolf, MD, MS (University of Iowa); James L. Carey, MD, MPH (University of Pennsylvania); and Warren R. Dunn, MD, MPH (University of Wisconsin).

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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