Department of Orthopaedics, Vanderbilt University Medical Center, 1215 21st Avenue South, 4200 Medical Center East, Nashville, TN 37232-8774, United States.
Attending Orthopaedic Surgeon, Kerlan Jobe Institute, 6801 Park Terrace, Los Angeles, CA 90045, United States.
Knee. 2021 Mar;29:564-570. doi: 10.1016/j.knee.2021.02.030. Epub 2021 Mar 26.
Anterior cruciate ligament reconstruction (ACLR) technique for femoral tunnel drilling varies substantially, each with advantages and disadvantages. The purpose of this study was to define ACLR femoral tunnel technique predilection among surgeons and to explore factors associated with their preference.
An 11-question survey regarding ACLR femoral tunnel technique was completed by 560 AANA/AOSSM members. Surgeon and practice demographics and residency and fellowship experiences were evaluated with bivariate and multivariable models for association with surgeon preference.
In current practice, 55% of surgeons prefer anteromedial (AM) portal drilling, 32% retrograde, and 14% transtibial (TT). Sports Medicine fellowship experience was the strongest predictor of current practice (p < 0.001), followed by residency technique (p = 0.014). A significant increase in TT drilling was noted for those practicing >15 years TT (29% vs 3%, p < 0.001), with an inverse relationship for retrograde drilling (38% vs 21%, p < 0.001). Number of ACLRs/year and percent Sports specific practice were significant predictors for AM drilling (p < 0.001). Though less than AM and retrograde, TT was more common for those in private practice (17% vs 8%, p < 0.001), and more prevalent in the Midwest/Southeast (19% vs 10%, p = 0.003). Non-significant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and Certificate of Added Qualifications status.
Surgeon training, practice setting, and years in practice significantly predict preference for femoral tunnel drilling technique. Surgeon comfort and confidence in attaining an anatomic reconstruction should drive choice of technique.
前交叉韧带重建（ACLR）股骨隧道钻取技术差异较大，各有优缺点。本研究旨在明确外科医生对 ACLR 股骨隧道技术的偏好，并探讨与其偏好相关的因素。
560 名 AANA/AOSSM 会员完成了一项关于 ACLR 股骨隧道技术的 11 项问题调查。通过双变量和多变量模型评估外科医生和实践的人口统计学以及住院医师和奖学金经验与外科医生偏好的关系。
在当前的实践中，55%的外科医生更喜欢经前内侧（AM）入路钻孔，32%喜欢逆行入路，14%喜欢经胫骨（TT）入路。运动医学奖学金经验是目前实践的最强预测因素（p<0.001），其次是住院医师技术（p=0.014）。对于 TT 经验超过 15 年的医生，TT 钻孔的比例显著增加（29%比 3%，p<0.001），逆行钻孔的比例则相反（38%比 21%，p<0.001）。每年 ACLR 的数量和运动专项实践的百分比是 AM 钻孔的显著预测因素（p<0.001）。尽管 TT 不如 AM 和逆行，但在私人执业的医生中更为常见（17%比 8%，p<0.001），在中西部/东南部更为普遍（19%比 10%，p=0.003）。非显著预测因素包括接受 ACLR 的运动员最高级别、担任球队医生的运动员级别以及额外资格证书的状态。
外科医生的培训、实践环境和从业年限显著预测了股骨隧道钻取技术的偏好。外科医生在获得解剖重建方面的舒适度和信心应该是技术选择的驱动因素。
