Changes in and current “best practices” for anterior cruciate ligament (ACL) reconstruction were the subject of a recent JBJS webinar that is available for free viewing until March 5, 2015.
The webinar focused on the procedural and outcome differences between nonanatomic transtibial tunnel drilling and more anatomic anteromedial portal drilling. Drs. Freddie Fu and Christopher Kaeding summarized their recent JBJS papers on ACL tunnel drilling, and Drs. Brett Owens and Darren Johnson commented on the authors’ findings. Dr. Mark Miller moderated the webinar.
One of several points the four ACL experts agreed upon during the webinar was the need for more objective outcome measures to help surgeons distinguish success from failure. For example, Dr. Fu argued for measuring outcomes with biomarkers and advanced imaging such as dynamic stereoradiography and 3-D computed tomography. As important as patient-centered outcomes are, Dr. Fu cited their subjectivity as a downside. “Getting back to sport in 6 months may not be so good if your ACL isn’t reconstructed anatomically,” he said.
Dr. Kaeding’s study found no KOOS-score differences between the two drilling techniques, but the transtibial group had a nearly 2.5-fold increased risk of subsequent ipsilateral knee surgery when compared to the anteromedial group. Commenting on that study, Dr. Johnson lauded the six-year follow-up and outcome metric of subsequent same-knee surgery. But he stressed that a combination of clinical outcomes–including patient satisfaction, knee stability, re-tear rates, and subsequent arthritis–would help surgeons make more informed decisions. He expressed hope that the patients in Dr. Kaeding’s study will continue to be followed so longer-term clinical data can been obtained.
To view the webinar in its entirety, free of charge, go to
https://vts.inxpo.com/Launch/QReg.htm?ShowKey=18001
You can also read a JBJS Reviews critical analysis of ACL tunnel placement here.