Open AccessSurgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries
Author(s) -
Rizvanovic Dzan,
Waldén Markus,
Forssblad Magnus,
Stålman Anders
Publication year - 2023
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-022-07057-5
Subject(s) - medicine , hamstring , odds ratio , confidence interval , anterior cruciate ligament reconstruction , logistic regression , patellar ligament , anterior cruciate ligament , surgery , quadriceps tendon , concomitant , sports medicine , patellar tendon , physical therapy , tendon
Purpose To investigate the influence of surgeon‐related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). Methods Data from the Swedish National Knee Ligament Registry (SNKLR), 2008–2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon‐/clinic‐related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low‐, mid‐ and high‐volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015–2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). Results 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high‐volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high‐volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11–1.79), but also for injury during handball (OR 1.31, 95% CI 1.02–1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24–2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18–5.80). In contrast, female sex (OR 0.87, 95% CI 0.77–0.97), injury during floorball (OR 0.71, 95% CI 0.55–0.91) and ACLR by mid‐volume relative to high‐volume surgeons (OR 0.62, 95% CI 0.53–0.73) had significantly reduced odds of receiving PT/QT autografts. Conclusion An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. Level of evidence Level III.