Summary
Higher surgical volume are associated with improved knee function and higher rates of meniscal repair during ACL reconstruction, emphasizing the importance of experience and precise injury management in optimizing long-term patient outcomes.
Abstract
Background
Surgical experience may play a crucial role in anterior cruciate ligament reconstruction (ACLR), influencing both patient-reported outcomes and meniscal management decisions. This project examined how surgeon experience affects knee function post-ACLR and how it impacts the decision to repair or resect meniscal tears. Understanding these relationships can help optimize surgical strategies and improve long-term patient outcomes.
Methods
A retrospective cohort study utilized data from the Swedish National Knee Ligament Registry (SNKLR), analyzing ACLR procedures from 2008 to 2022.
Study on Surgical Experience and Patient Outcomes:
Compared outcomes between high-experience surgeons (HES) (=50 total ACLRs, =29 ACLRs/year) and low-experience surgeons (LES) (<50 total ACLRs, <29 ACLRs/year).
Primary outcome: Patient-reported knee function using KOOS4 at two years.
Secondary outcome: ACL revision rates.
Study on Surgical Experience and Meniscal Management:
Evaluated how surgeon experience influenced the choice between meniscal repair and resection during ACLR.
Primary outcome: Rate of medial meniscus (MM) and lateral meniscus (LM) repair versus resection.
Secondary outcome: Factors influencing meniscal treatment, such as age, sex, time from injury to surgery, and chondral injuries.
Multivariable logistic regression adjusted for potential confounders.
Results
Surgical Experience and Patient Outcomes:
Patients treated by high-experience surgeons reported better KOOS4 scores at two years (75.6 vs. 69.9, p<0.05).
PASS (Patient Acceptable Symptom State) was achieved at a higher degree in the more experienced surgeon group (p<0.05).
No significant difference in ACL revision rates was found between groups.
Surgical Experience and Meniscal Management:
High-experience surgeons performed more meniscal repairs than low-experience surgeons (29.8% vs. 13.3%, p<0.001). The odds of medial meniscus repair were lower in surgeries performed by low-experience surgeons (OR 0.82, p=0.015). Clinic volume influenced lateral meniscus repair rates more strongly (OR 0.62, p<0.001).
Discussion
The findings highlight that greater surgical experience leads to better patient-reported outcomes and a preference for meniscal repair over resection. High-experience surgeons achieve higher KOOS4 scores and PASS rates, suggesting superior surgical technique and decision-making.The greater use of meniscal repair by experienced surgeons aligns with best practices to preserve knee function and delay osteoarthritis. However, meniscal resections remained common, likely due to tear complexity or surgeon preference. The absence of significant differences in ACL revision rates suggests that functional improvements stem from the initial surgery rather than revision frequency.These results may underscore the need to centralize ACLR procedures to experienced surgeons to enhance patient outcomes and optimize meniscal preservation.
Conclusion
Surgical experience significantly impacts both meniscal management and postoperative knee function in ACLR. High-experience surgeons favor meniscal repair, leading to better patient-reported outcomes. These findings reinforce the importance of expertise-driven treatment strategies and suggest that ACL surgeries should be performed by experienced surgeons to optimize long-term knee health.