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Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure

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Abstract
Purpose: Studies on dynamic intraligamentary stabilization (DIS) of acute anterior cruciate ligament (ACL) ruptures reported failure rates similar to those of conventional ACL reconstruction. This study aimed to determine whether surgeon experience with DIS is associated with revision rates or patient-reported outcomes. The hypothesis was that more experienced surgeons achieved better outcomes following DIS due to substantial learning curve. Methods: The authors prospectively enrolled 110 consecutive patients that underwent DIS and evaluated them at a minimum of 2 years. The effects of independent variables (surgeon experience, gender, age, adjuvant procedures, tear location, preinjury Tegner score, time from injury to surgery, and follow-up) on four principal outcomes (revision ACL surgery, any re-operation, IKDC and Lysholm score) were analyzed using univariable and multivariable regressions. Results: From the 110 patients enrolled, 14 patients (13%) were lost to follow-up. Of the remaining 96 patients, 11 underwent revision ACL surgery, leaving 85 patients for clinical assessment at a mean of 2.2 +/- 0.4 years (range 2.0-3.8). Arthroscopic reoperations were performed in 26 (27%) patients, including 11 (11%) revision ACL surgeries. Multivariable regressions revealed: (1) no associations between the reoperation rate and the independent variables, (2) better IKDC scores for 'designer surgeons' (b = 10.7; CI 4.9-16.5; p < 0.001), higher preinjury Tegner scores (b = 2.5, CI 0.8-4.2; p = 0.005), and younger patients (b = 0.3, CI 0.0-0.6; p = 0.039), and (3) better Lysholm scores for 'designer surgeons' (b = 7.8, CI 2.8-12.8; p = 0.005) and preinjury Tegner score (b = 1.9, CI 0.5-3.4; p = 0.010). Conclusion: Surgeon experience with DIS was not associated with rates of revision ACL surgery or general re-operations. Future, larger-scaled studies are needed to confirm these findings. Patients operated by 'designer surgeons' had slightly better IKDC and Lysholm scores, which could be due to better patient selection and/or positively biased attitudes of both surgeons and patients.
Keywords
Anterior cruciate ligament, Dynamic intraligamentary stabilization, Ligamys, Revision surgery, Surgeon experience, Outcomes, ANTERIOR CRUCIATE LIGAMENT, ACL RECONSTRUCTION, ACTIVITY LEVEL, KNEE REINJURY, GRAFT TYPE, FOLLOW-UP, INJURY, PREDICTORS, REPAIR, COHORT

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Citation

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Chicago
Henle, Philipp, Kathrin S Bieri, Janosch Haeberli, Nele Arnout, Jan Victor, Mirco Herbort, Clemens Koesters, and Stefan Eggli. 2018. “Surgeon Experience with Dynamic Intraligamentary Stabilization Does Not Influence Risk of Failure.” Knee Surgery Sports Traumatology Arthroscopy 26 (10): 2978–2985.
APA
Henle, P., Bieri, K. S., Haeberli, J., Arnout, N., Victor, J., Herbort, M., Koesters, C., et al. (2018). Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 26(10), 2978–2985.
Vancouver
1.
Henle P, Bieri KS, Haeberli J, Arnout N, Victor J, Herbort M, et al. Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2018;26(10):2978–85.
MLA
Henle, Philipp et al. “Surgeon Experience with Dynamic Intraligamentary Stabilization Does Not Influence Risk of Failure.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 26.10 (2018): 2978–2985. Print.
@article{8551050,
  abstract     = {Purpose: Studies on dynamic intraligamentary stabilization (DIS) of acute anterior cruciate ligament (ACL) ruptures reported failure rates similar to those of conventional ACL reconstruction. This study aimed to determine whether surgeon experience with DIS is associated with revision rates or patient-reported outcomes. The hypothesis was that more experienced surgeons achieved better outcomes following DIS due to substantial learning curve. 
Methods: The authors prospectively enrolled 110 consecutive patients that underwent DIS and evaluated them at a minimum of 2 years. The effects of independent variables (surgeon experience, gender, age, adjuvant procedures, tear location, preinjury Tegner score, time from injury to surgery, and follow-up) on four principal outcomes (revision ACL surgery, any re-operation, IKDC and Lysholm score) were analyzed using univariable and multivariable regressions. 
Results: From the 110 patients enrolled, 14 patients (13%) were lost to follow-up. Of the remaining 96 patients, 11 underwent revision ACL surgery, leaving 85 patients for clinical assessment at a mean of 2.2 +/- 0.4 years (range 2.0-3.8). Arthroscopic reoperations were performed in 26 (27%) patients, including 11 (11%) revision ACL surgeries. Multivariable regressions revealed: (1) no associations between the reoperation rate and the independent variables, (2) better IKDC scores for 'designer surgeons' (b = 10.7; CI 4.9-16.5; p < 0.001), higher preinjury Tegner scores (b = 2.5, CI 0.8-4.2; p = 0.005), and younger patients (b = 0.3, CI 0.0-0.6; p = 0.039), and (3) better Lysholm scores for 'designer surgeons' (b = 7.8, CI 2.8-12.8; p = 0.005) and preinjury Tegner score (b = 1.9, CI 0.5-3.4; p = 0.010). 
Conclusion: Surgeon experience with DIS was not associated with rates of revision ACL surgery or general re-operations. Future, larger-scaled studies are needed to confirm these findings. Patients operated by 'designer surgeons' had slightly better IKDC and Lysholm scores, which could be due to better patient selection and/or positively biased attitudes of both surgeons and patients.},
  author       = {Henle, Philipp and Bieri, Kathrin S and Haeberli, Janosch and Arnout, Nele and Victor, Jan and Herbort, Mirco and Koesters, Clemens and Eggli, Stefan},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keywords     = {Anterior cruciate ligament,Dynamic intraligamentary stabilization,Ligamys,Revision surgery,Surgeon experience,Outcomes,ANTERIOR CRUCIATE LIGAMENT,ACL RECONSTRUCTION,ACTIVITY LEVEL,KNEE REINJURY,GRAFT TYPE,FOLLOW-UP,INJURY,PREDICTORS,REPAIR,COHORT},
  language     = {eng},
  number       = {10},
  pages        = {2978--2985},
  title        = {Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure},
  url          = {http://dx.doi.org/10.1007/s00167-018-4847-0},
  volume       = {26},
  year         = {2018},
}

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