The learning curve associated with anteromedial portal drilling in ACL reconstruction

Luthringer, Tyler A.; Blackmore, Shane A.; Singh, Brian C.; Strauss, Eric J.

doi:10.1080/00913847.2016.1154448

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…Additional benefits have also been described including the improved bird's-eye view of the tibial footprint during tunnel positioning [5]. We found any required meniscal and chondral work also relatively easy with the 70°arthroscope, although in a less experienced group a greater learning curve may be expected (as seen with other ACL techniques) [24,25].…”

Section: Discussionmentioning

confidence: 60%

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Kosy

Walmsley

Sharma

et al. 2020

Knee Surg & Relat Res

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Background: Graft malposition is a risk factor for failure of anterior cruciate ligament reconstruction. A 70°a rthroscope improves visualisation of the medial wall of the lateral femoral condyle without switching portals. We investigated whether the use of this arthroscope affected the accuracy and precision of femoral tunnel placement. Methods: Fifty consecutive adult patients were recruited. Following one withdrawal and two exclusions, 47 patients (30 in group 1 (70°arthroscope), 17 in group 2 (30°arthroscope)) underwent three-dimensional computed tomography imaging using a grid-based system to measure tunnel position. Results: No difference was found in the accuracy or precision of tunnels (mean position: group 1 = 33.3 ± 6.0% deep-shallow, 27.2 ± 5.2% high-low; group 2 = 31.7 ± 6.9% deep-shallow, 29.0 ± 6.2% high-low; not significant). A post-hoc power analysis suggests a study of 106 patients would be required. Conclusions: This pilot study suggests that tunnel position is not affected by the arthroscope used. An appropriately powered study could investigate this finding alongside other potential benefits of using a 70°a rthroscope for this procedure.

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Section: Discussionmentioning

confidence: 60%

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Kosy

Walmsley

Sharma

et al. 2020

Knee Surg & Relat Res

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“…Surgeons with only two registered years were defined as low‐, mid‐ or high‐volume by the median of the two values, while surgeons active for only 1 year in the registry were classified according to the single annual value of ACLRs/revisions. A cut‐off for registry caseload of ≥ 50 operations was used, since the number of consecutive procedures to perform an ACLR more accurately and with an improved technique has been suggested as a surgeon caseload of around 50 operations on average [1, 23, 24, 40]. The ability to use different graft types was based on whether the surgeon performed at least one primary ACLR with a certain graft.…”

Section: Methodsmentioning

confidence: 99%

Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Rizvanovic

Waldén

Forssblad

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). Methods Data from the Swedish National Knee Ligament Registry (SNKLR), 2008–2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015–2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). Results 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high-volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11–1.79), but also for injury during handball (OR 1.31, 95% CI 1.02–1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24–2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18–5.80). In contrast, female sex (OR 0.87, 95% CI 0.77–0.97), injury during floorball (OR 0.71, 95% CI 0.55–0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53–0.73) had significantly reduced odds of receiving PT/QT autografts. Conclusion An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. Level of evidence Level III.

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“…Concomitant meniscal surgery (meniscectomy) was not considered an exclusion criterion. All the procedures were performed by two of the authors experienced in the use of hamstring and allograft for ACL reconstruction, respectively, and all the patients followed a similar postoperative rehabilitation protocol [9,10].…”

Section: Methodsmentioning

confidence: 99%

Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression

D’Ambrosi

Giorgino

Corona

et al. 2022

International Orthopaedics (SICOT)

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Purpose The aim of this study is to compare the functional outcomes and osteoarthritis (OA) progression after anterior cruciate ligament (ACL) reconstruction with either hamstring autografts or allografts in people over 50. Methods The clinical records of two consecutive cohorts of 61 cases in total over 50 years of age, undergoing ACL reconstruction, were included. The first cohort consisted of 29 allografts; the second cohort consisted of 32 autologous hamstring tendon grafts. The cases were evaluated pre- (T0) and post-operatively at six months (T1), 12 months (T2) and 24 months (T3). Clinical examination included the Lachman test, pivot shift test and objective (Objective IKDC [The International Knee Documentation Committee] score) and subjective clinical scores (Subjective IKDC score, Lysholm score and Tegner activity score). The degree of OA was evaluated using the Kellgren-Lawrence system at the time of the final follow-up, compared to the pre-operative condition. Results No pre-operative difference was found between the two groups (p > 0.05). No statistical difference was noted between the two groups at each follow-up (p > 0.05). At the final follow-up, both the groups significantly improved statistically in all the clinical and functional scores (p < 0.05). In both groups, one graft re-rupture was noted. No progression of OA was noted in both groups at final follow-up (p > 0.05). Conclusion The graft choice does not influence the outcomes two years after ACL reconstruction in people over 50; thus, both treatments help in regaining knee stability with no signs of OA progression. Registration Researchregistry7539–www.researchregistry.com.

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The learning curve associated with anteromedial portal drilling in ACL reconstruction

Abstract: A learning curve in developing accuracy and precision in ACL femoral tunnel placement using the AMP technique exists; our study indicates this to be somewhere between 32 and 64 cases. Tibial tunnel placement does not share the same learning curve using this surgical technique.

Cited by 14 publications

References 15 publications

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study

Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression

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