No differences in subjective knee function between surgical techniques of anterior cruciate ligament reconstruction at 2-year follow-up: a cohort study from the Swedish National Knee Ligament Register

Abstract

PurposeThe purpose of this study was to investigate how different techniques of single-bundle anterior cruciate ligament (ACL) reconstruction affect subjective knee function via the Knee injury and Osteoarthritis Outcome Score (KOOS) evaluation 2 years after surgery. It was hypothesized that the surgical techniques of single-bundle ACL reconstruction would result in equivalent results with respect to subjective knee function 2 years after surgery.MethodsThis cohort study was based on data from the Swedish National Knee Ligament Register during the 10-year period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstrings tendon autograft were included. Details on surgical technique were collected using a web-based questionnaire comprised of essential AARSC items, including utilization of accessory medial portal drilling, anatomic tunnel placement, and visualization of insertion sites and landmarks. A repeated measures ANOVA and an additional linear mixed model analysis were used to investigate the effect of surgical technique on the KOOS4 from the pre-operative period to 2-year follow-up.ResultsA total of 13,636 patients who had undergone single-bundle ACL reconstruction comprised the study group for this analysis. A repeated measures ANOVA determined that mean subjective knee function differed between the pre-operative time period and at 2-year follow-up (p < 0.001). No differences were found with respect to the interaction between KOOS4 and surgical technique or gender. Additionally, the linear mixed model adjusted for age at reconstruction, gender, and concomitant injuries showed no difference between surgical techniques in KOOS4 improvement from baseline to 2-year follow-up. However, KOOS4 improved significantly in patients for all surgical techniques of single-bundle ACL reconstruction (p < 0.001); the largest improvement was seen between the pre-operative time period and at 1-year follow-up.ConclusionSurgical techniques of primary single-bundle ACL reconstruction did not demonstrate differences in the improvement in baseline subjective knee function as measured with the KOOS4 during the first 2 years after surgery. However, subjective knee function improved from pre-operative baseline to 2-year follow-up independently of surgical technique.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-017-4521-y) contains supplementary material, which is available to authorized users.

ACL Reconstruction Graft Angle and Outcomes: Transtibial vs Anteromedial Reconstruction

“…Some of the limitations of this study include a lack of pre-operative KOOS data, which means we were unable to accurately determine the change in KOOS scores between groups; however, the post-operative KOOS scores are excellent in both groups and consistent with other reported outcomes [9, 16]. Clinical follow-up was performed by unblinded staff, and graft type (autograft or allograft) had an uneven distribution between groups.…”

Medium-Term (Least 5 Years) Comparative Outcomes in Anterior Cruciate Ligament Reconstruction Using 4SHG, Allograft, and LARS Ligament

“…But, Ardern et al 49 reported less than 50% of the patients returned to the preinjury level, or to competitive sport participation during the 2 to 7 years after ACLR. Hamrin et al 50 found that single-bundle ACLR did not significantly improve subjective knee function through the KOOS evaluation after 2 consecutive annual clinic visits. This study also found that preoperative (after injury) subjective scores were lower than postoperative subjective scores and postoperative subjective scores were lower than preinjury subjective scores as measured with Tegner activity level.…”

International cooperation needed to improve national anterior cruciate ligament registries

“…The target is 100% coverage of the number of registered operation reports. A yearly check is made with the Swedish Board of Health and Welfare regarding the ID number [5]. The register is in line with the Swedish legislation on data security.…”