Surgeon experience with dynamic intraligamentary stabilization does not influence risk of failure
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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 of evidence
Level II, prospective comparative study.
KeywordsAnterior cruciate ligament Dynamic intraligamentary stabilization Ligamys Revision surgery Surgeon experience Outcomes
The authors thank Mo Saffarini (ReSurg SA) for editorial assistance.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
All authors have received reimbursements or funding from Mathys AG Bettlach, Switzerland, in the past 5 years. The authors are not compensated for this work.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from the participants included in this study.
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