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More revisions found with anteromedial drilling technique for ACL reconstruction

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GENEVA — Danish registry results showed the introduction of the anteromedial technique for drilling femoral tunnels for ACL reconstruction was associated with a 4.7% revision rate at 3-year follow-up compared with 2.6% for the traditional transtibial technique.

According to a presentation by Lene R. Wagner, MD, at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress (ESSKA) 2012, Danish researchers analyzed data for 8,375 primary ACL procedures in a web-based national clinical database performed between January 2007 and December 2010 that involved either femoral drilling approach. They identified a 2.01 risk of revision for the anteromedial (AM) femoral drilling technique. After adjusting for confounders, Wagner and colleagues calculated the risk of revision for the AM method of drill hole placement increased to 2.04, according to the abstract.

“Based on this national cohort study, a higher revision rate is seen in the anteromedial group compared to the transtibial group,” Wagner said. “A higher rate of positive pivot shift was seen in the anteromedial group. These results are very surprising and future studies need to look into causality of this.”

Wagner noted in her presentation that she and colleagues looked at gender, patient age less than 20 years, cartilage damage, prior knee surgery and meniscus treatment as additional relevant confounders, which did not alter the results.

Reference:

Wagner LR, Thillemann T, Mehnert F, et al. Increased risk of ACL revision after anteromedial compared to transtibial technique for femoral drill hole placement during ACL reconstruction. Result from the Danish registry of knee ligament reconstruction. Paper #AW10-516. Presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress Congress 2012. May 2-5. Geneva.

Disclosure: Wagner has no relevant financial disclosures.