Department of Knee Surgery and Sports Traumatology, Sonnenhof Orthopaedic Center, Bern, Switzerland.
Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):2978-2985. doi: 10.1007/s00167-018-4847-0. Epub 2018 Feb 5.
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.
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.
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).
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.
Level II, prospective comparative study.
研究显示，对于急性前交叉韧带（ACL）撕裂，动态关节内稳定（DIS）的失败率与传统 ACL 重建相似。本研究旨在确定外科医生在 DIS 方面的经验是否与翻修率或患者报告的结果相关。假设是，经验丰富的外科医生由于经历了实质性的学习曲线，因此在进行 DIS 后能够取得更好的结果。
作者前瞻性地招募了 110 例连续接受 DIS 的患者，并在至少 2 年时进行评估。使用单变量和多变量回归分析，分析了独立变量（外科医生经验、性别、年龄、辅助手术、撕裂位置、受伤前 Tegner 评分、受伤至手术时间和随访时间）对四个主要结局（ACL 翻修手术、任何再手术、IKDC 和 Lysholm 评分）的影响。
在纳入的 110 例患者中，有 14 例（13%）失访。在其余 96 例患者中，有 11 例接受了 ACL 翻修手术，85 例患者在平均 2.2±0.4 年（范围 2.0-3.8 年）时进行了临床评估。26 例（27%）患者进行了关节镜下再次手术，其中包括 11 例（11%）ACL 翻修手术。多变量回归显示：（1）再手术率与独立变量之间无关联；（2）“设计医生”的 IKDC 评分更好（b=10.7；CI 4.9-16.5；p<0.001），受伤前 Tegner 评分更高（b=2.5；CI 0.8-4.2；p=0.005），年轻患者（b=0.3；CI 0.0-0.6；p=0.039）；（3）“设计医生”的 Lysholm 评分更好（b=7.8；CI 2.8-12.8；p=0.005）和受伤前 Tegner 评分更好（b=1.9；CI 0.5-3.4；p=0.010）。
外科医生在 DIS 方面的经验与 ACL 翻修手术或一般再手术的发生率无关。未来需要更大规模的研究来证实这些发现。由“设计医生”进行手术的患者的 IKDC 和 Lysholm 评分略高，这可能是由于更好的患者选择以及外科医生和患者的积极偏见。
二级，前瞻性比较研究。
