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.
OBJECTIVE
The 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.


METHODS
This 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 KOOS4from the pre-operative period to 2-year follow-up.


RESULTS
A 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 KOOS4and 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 KOOS4improvement from baseline to 2-year follow-up. However, KOOS4improved 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.


CONCLUSIONS
Surgical techniques of primary single-bundle ACL reconstruction did not demonstrate differences in the improvement in baseline subjective knee function as measured with the KOOS4during the first 2 years after surgery. However, subjective knee function improved from pre-operative baseline to 2-year follow-up independently of surgical technique.
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Eric
E
Hamrin Senorski
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
David
D
Sundemo
Department of Orthoapedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Christopher D
CD
Murawski
Fundación García-Cugat, Barcelona, Spain.|Artroscopia GC, SL, Barcelona, Spain.|Mutualidad Catalana de Futbolistas - Delegación Cataluña, Federación Española de Fútbol, Barcelona, Spain.|Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
Eduard
E
Alentorn-Geli
Department of Orthoapedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Volker
V
Musahl
Department of Orthoapedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Freddie
F
Fu
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.|Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Neel
N
Desai
Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
Anders
A
Stålman
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. kristian@samuelsson.cc.|Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden. kristian@samuelsson.cc.
Kristian
K
Samuelsson
D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000453:epidemiology* / Q000534:rehabilitation / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012042:Registries; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014182:Transplantation, Autologous; D055815:Young Adult
ACL; Anatomic; Anterior cruciate ligament; Checklist; KOOS; Patient-reported outcome; Register