Document Detail

Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the danish knee ligament reconstruction register.
MedLine Citation:
PMID:  23276417     Owner:  NLM     Status:  In-Data-Review    
PURPOSE: The goal was to study revision rates and clinical outcome after anterior cruciate ligament (ACL) reconstruction using the anteromedial (AM) technique versus the transtibial (TT) technique for femoral drill hole placement.
METHODS: A total of 9,239 primary ACL reconstruction procedures were registered in the Danish Knee Ligament Reconstruction Register between January 2007 and December 2010. The failure of the 2 different femoral drilling techniques was determined using revision ACL reconstruction as the primary endpoint. As secondary endpoints, we used the pivot-shift test and instrumented objective test as well as patient-reported outcome, registered in the Danish Knee Ligament Reconstruction Register. Relative risks (RRs) with 95% confidence intervals (CI) were calculated.
RESULTS: We identified 1,945 AM and 6,430 TT primary ACL procedures. The cumulative revision rates for ACL reconstruction after 4 years with the AM and TT techniques were 5.16% (95% CI: 3.61%, 7.34%) and 3.20% (95% CI: 2.51%, 4.08%), respectively. The adjusted overall RR for revision ACL surgery in the AM group was 2.04 (95% CI: 1.39, 2.99), compared with the TT group. Use of the AM technique increased from 13% of all operations in 2007 to 40% in 2010. AM technique was further associated with increased RRs of positive pivot shift of 2.86 (95% CI: 2.40, 3.41) and sagittal instability of 3.70 (95% CI: 3.09, 4.43), compared with the TT technique.
CONCLUSIONS: This study found an increased risk of revision ACL surgery when using the AM technique for femoral drill hole placement, compared with the TT technique, in the crude data as well as the stratified and adjusted data. Our finding could be explained by technical failures resulting from introduction of a new and more complex procedure or by the hypothesis put forward in prior studies that compared with a nonanatomic graft placement, a greater force is carried by the anatomic ACL reconstruction and, hence, there is a concomitant higher risk of ACL rupture.
LEVEL OF EVIDENCE: Level II, prospective comparative study.
Lene Rahr-Wagner; Theis Muncholm Thillemann; Alma Becic Pedersen; Martin Carøe Lind
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  29     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-105     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Division of SportsTrauma, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address:
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