Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstru
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Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Registry Martin Lind1 · Marc J. Strauss2 · Torsten Nielsen1 · Lars Engebretsen2 Received: 31 May 2020 / Accepted: 6 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Recent registry data have demonstrated a higher revision rate of quadriceps tendon (QT) graft compared with hamstring tendon (HT) and patellar tendon (PT) grafts. Clinic routines could be an important factor for revision outcomes. The purpose of this study is to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates in patients who have undergone ACLR with QT, HT and PT grafts related to individual clinic surgical routine. Methods Data on primary ACLRs entered in the DKRR from 2012 through 2019 were analysed since QT graft usage started in 2012. Revision rates for QT, HT and PT grafts were compared according to clinic activity (0–100 and > 100 procedures). Revision rates for the three autograft cohorts are presented, as well as adjusted revision hazard rates. Instrumented knee stability and pivot-shift tests were performed at a one-year follow-up. Result QT revision rate (6.4%) for low-activity clinics was higher than for high-activity clinics (2.9%) (p = 0.003). The adjusted revision hazard ratio for low-activity clinics was 2.3 (p = 0.01). QT autograft was associated with statistically significant, increased side-to-side laxity at follow-up (1.4 mm) compared with HT and PT autografts (1.0 mm) (p 100 procedures). The descriptive data are presented as means and standard deviations and compared with the Student’s-t test or the Chisquare test for proportional data. The Cox regression analysis was used to compare the revision risk within the first 2 years after primary ACL surgery among patients in the three graft groups. By applying the Kaplan–Meier method, the revision probability was estimated for the three graft groups for the total follow-up period. Hazard ratios were computed as measures of relative risk (RR), both crudely and adjusted for potentially confounding factors. The included confounding factors were gender, age (≤ 20 and > 20 years), cartilage damage > 1 cm2 (no/yes or missing data) and surgical treatment of meniscal injury, either resection or repair (yes/ no or missing data). The confounding factors were chosen Table 1 Demographic data for the three graft groups
Fig. 1 Kaplan–Meier revision estimates. Revision rates of the three autograft cohorts in high-activity clinics (> 100 procedures). Adjusted hazard rates were not different between graft types. ACL, anterior cruciate ligament, QT, quadriceps tendon, HT, hamstring tendon, PT, patellar tendon
Graft groups
QT
HT
PT
QT vs HT
PT vs QT
PT vs HT
N total Age (mean ± SD) Male (%) Injury in sports (%) Meniscus injury (%) Cartilage injury (%) Operation time (mean ± SD)
1194 25.5 ± 8.3 65 88 56 27 86
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