0
Scientific Articles   |    
Transtibial ACL Femoral Tunnel Preparation Increases Odds of Repeat Ipsilateral Knee Surgery
Andrew Duffee, MD1; Robert A. Magnussen, MD2; Angela D. Pedroza, MPH2; David C. Flanigan, MD2; Christopher C. Kaeding, MD2; MOON Group
1 Shelbyville Orthopaedics and Sports Medicine, 101 Stonecrest, #2, Shelbyville, KY 40065
2 Department 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
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at The Ohio State University, Columbus, Ohio

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); and James L. Carey, MD, MPH (University of Pennsylvania).



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Nov 20;95(22):2035-2042. doi: 10.2106/JBJS.M.00187
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

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.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/08/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    04/16/2014
    Ohio - OhioHealth Research and Innovation Institute (OHRI)