No difference in revision rates between anteromedial portal and transtibial drilling of the femoral graft tunnel in primary anterior cruciate ligament reconstruction: early results from the New Zealand ACL Registry.,Knee Surgery, Sports Traumatology, Arthroscopy

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No difference in revision rates between anteromedial portal and transtibial drilling of the femoral graft tunnel in primary anterior cruciate ligament reconstruction: early results from the New Zealand ACL Registry.
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.3 ) Pub Date : 2020-04-01 , DOI: 10.1007/s00167-020-05959-w
Richard Rahardja ₁ , Mark Zhu _{1,

2} , Hamish Love ₃ , Mark G Clatworthy ₄ , Andrew Paul Monk _{1,

2} , Simon W Young _{1,

5}

Affiliation

Purpose

The use of an accessory anteromedial portal to drill the femoral graft tunnel in primary anterior cruciate ligament (ACL) reconstruction was introduced in the 2000s in an effort to achieve a more anatomic femoral tunnel position. However, some early studies reported an increase in revision ACL reconstruction compared to the traditional transtibial technique. The aim of this study was to analyse recent data recorded by the New Zealand ACL Registry to compare outcomes of ACL reconstruction performed using the anteromedial portal and transtibial techniques.

Methods

Analysis was performed on primary isolated single-bundle ACL reconstructions recorded between 2014 and 2018 by the New Zealand ACL Registry. Patients were categorised into two groups according to whether an anteromedial portal or transtibial technique was used to drill the femoral graft tunnel. The primary outcome was revision ACL reconstruction and was compared between both groups through univariate and multivariate survival analyses. The secondary outcomes that were analysed included subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Marx activity score.

Results

Six thousand one hundred and eighty-eight primary single-bundle ACL reconstructions were performed using either the anteromedial portal or transtibial drilling techniques. The mean time of follow-up was 23.3 (SD ± 14.0) months. Similar patient characteristics such as mean age (29 years, SD ± 11), sex (males = 58% versus 57%) and time to surgery (median 4 months, IQR 5) were observed between both groups. The rate of revision ACL reconstruction was 2.6% in the anteromedial portal group and 2.2% in the transtibial group (n.s.). The adjusted risk of revision ACL reconstruction was 1.07 (95% CI 0.62–1.84, n.s.). Patients in the anteromedial portal group reported improved scores for subscales of the KOOS and higher Marx activity scores at 1-year post-reconstruction.

Conclusion

There was no difference in the risk of revision ACL reconstruction between the two femoral tunnel drilling techniques at short-term follow-up. We observed minor differences in patient-reported outcomes at 1-year follow-up favouring the anteromedial portal technique, which may not be clinically relevant. Surgeons can achieve good clinical outcomes with either drilling technique.

Level of evidence

III.

中文翻译：

在前交叉韧带重建中，股骨移植隧道的前内侧门和胫骨钻孔的翻修率无差异：新西兰ACL注册中心的早期结果。

目的

在2000年代开始使用辅助性前内侧门在股骨前交叉韧带（ACL）重建中钻孔股骨移植隧道，以实现更解剖的股骨隧道位置。但是，一些早期的研究报道，与传统的胫骨技术相比，修订版ACL重建的数量有所增加。这项研究的目的是分析新西兰ACL注册中心记录的最新数据，以比较使用前内侧门和胫骨技术进行ACL重建的结果。

方法

新西兰ACL注册管理机构对2014年至2018年之间记录的主要孤立单束ACL重建进行了分析。根据是否使用前内侧门或胫骨技术来钻孔股骨隧道，将患者分为两组。主要结果是修订ACL重建，并通过单因素和多因素生存分析对两组进行了比较。分析的次要结果包括膝关节损伤和骨关节炎结果评分（KOOS）和马克思活动评分的子量表。

结果

使用前内侧门或胫骨钻孔技术进行了168例主要的单束ACL重建。平均随访时间为23.3（SD±14.0）个月。在两组之间观察到相似的患者特征，例如平均年龄（29岁，SD±11），性别（男性= 58％对57％）和手术时间（中位数4个月，IQR 5）。前房门组的ACL翻修率是2.6％，后胫骨组是2.2％（ns）。修订后的ACL重建风险为1.07（95％CI 0.62-1.84，ns）。前房门组的患者在重建后1年时报告了KOOS量表的得分得到改善，而马克思活动得分更高。