Factors Influencing Graft Choice in Revision Anterior Cruciate Ligament Reconstruction in the MARS Group.
Factors Influencing Graft Choice in Revision Anterior Cruciate Ligament Reconstruction in the MARS Group.
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DOI：
10.1055/s-0035-1564723
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
MARS Group
中科院分区：
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作者：
MARS Group
在过去，尚不清楚是什么因素推动了翻修前交叉韧带重建移植物的选择。我们开展了这项研究，利用MARS(多中心前交叉韧带翻修研究)队列和倾向评分统计分析来确定前交叉韧带翻修重建移植物选择的驱动因素。我们假设倾向性分析将证明个别外科医生仍然对翻修前交叉韧带重建有显著影响。来自52个地点的83名外科医生在这个纵向修订队列中登记了1200名患者。中位年龄为26岁，505例(42%)为女性。1049人(87%)正在接受第一次前交叉韧带修订。对于这些患者，翻修前交叉韧带重建的移植物选择是48%的自体移植物，49%的同种异体移植物和3%的联合移植物。该模型的自变量包括性别、年龄、种族、BMI、吸烟状况、运动、活动水平、既往移植物、翻修次数、外科医生、外科医生对失败的看法、既往技术方面等。我们根据Logistic回归模型预测的接受同种异体移植物的概率，计算了移植物类型的倾向评分。倾向评分显示，外科医生、移植物选择和患者年龄对选择何种移植物类型进行翻修前交叉韧带重建均有显著影响(p<；0.0001)。翻修外科医生对移植物选择的影响最大：大约是第二重要因素(先前移植物)的5倍。如果之前的移植物类型是自体移植物，那么选择同种异体移植物进行翻修的可能性是自体移植物的3.6倍。目前的研究表明，个体外科医生最终是翻修前交叉韧带重建移植物选择的最重要因素。移植物选择的其他有统计学意义的影响包括年龄、性别、既往移植物选择、前交叉韧带翻修次数、同时行MCL/PM修复以及对既往失败的看法。这表明，如果移植物的选择被确定为影响结果，那么外科医生有能力改变和确定所使用的移植物。
It has not been known what drives revision ACL reconstruction graft choice in the past. We undertook this study to utilize the MARS (Multicenter ACL Revision Study) cohort and propensity score statistical analysis to determine the drivers of revision ACL reconstruction graft choice. We hypothesized that propensity analysis would demonstrate that individual surgeons still have significant impact on revision ACL reconstruction. Twelve hundred patients were enrolled in this longitudinal revision cohort by 83 surgeons at 52 sites. The median age was 26 years and 505 (42%) were females. 1049 (87%) were undergoing their first ACL revision. Graft choice for revision ACL reconstruction for these patients was 48% autograft, 49% allograft, and 3% combination. The independent variables of this model included gender, age, ethnicity, BMI, smoking status, sport, activity level, previous graft, revision number, surgeon, surgeon’s opinion of failure, previous technical aspects, etc. Surgeon was defined as those who contributed more than 15 patients during the enrollment period. We calculated a propensity score for graft type based on the predicted probability of receiving an allograft from a logistic regression model. Propensity scores demonstrated that surgeon, prior graft choice, and patient age each had significant influence on which graft type was chosen for the revision ACL reconstruction (p<0.0001). The revising surgeon had the largest impact upon graft choice: approximately 5 times that of the second most important factor (prior graft). If the prior graft type was an autograft, then an allograft was 3.6 times more likely to be chosen for the revision. This current study demonstrates that the individual surgeon is ultimately the most important factor in revision ACL reconstruction graft choice. Additional statistically significant influences of graft choice included age, gender, previous graft choice, ACL revision number, concurrent MCL/PM repair, and opinion of the previous failure. This demonstrates that if graft choice is determined to impact outcome then surgeons have the ability to change and determine the graft utilized.