http://www.revistadechimie.ro REV.CHIM.(Bucharest)♦69♦No. 10 ♦2018 2874 The Learning Curve in Arthroscopic ACL Reconstruction The impact on the Surgical Time and Postoperative Clinical Results TEODOR NEGRU 1 , STEFAN MOGOS 1,2 *, IOAN CRISTIAN STOICA 1,2 1 Foisor Orthopedics Hospital Bucharest, 35-37 Bd. Ferdinand I Blvd.,021382, Bucharest, Romania 2 Carol Davila University of Medicine and Pharmacy, 39 Str. Dionisie Lupu Str., 010458, Bucharest, Romania Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up. Keywords: Anterior cruciate ligament, learning curve, clinical outcomes, surgical time Rupture of the anterior cruciate ligament (ACL) is a common injury with an incidence of 25-78 per 100,000 [1- 3]. Around a third of the patients undergo surgical reconstruction [2] and this, therefore, represents one of the most common orthopaedic procedures in sports medicine [3]. Despite this, considerable controversy still exists regarding nearly all aspects of ACL surgery [3, 4]. The surgical goal is to stabilize the knee joint without restricting the range of motion and prevent secondary damage within an unstable joint like meniscal and cartilage lesions [3-5]. Complex issues have to be addressed in order to achieve the appropriate results [6]. Arthroscopic ACLR is widely accepted as the standard of care for active individuals with functional instability of the knee joint related to ACL injury [7, 8] and surgeons must pass through a learning curve in order to master an ACL reconstruction technique. The achievement of arthroscopic technical proficiency is a complex task. Early arthroscopic learning can be associated with iatrogenic injury, often as damage to articular cartilage [9- 12]. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single- bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. Experimental part Institutional Review Board approval was obtained. The current study is a retrospective study evaluating patients from a prospectively collected database. A number of 93 patients undergoing anatomic single bundle ACLR between * email: stefan.mogos@gmail.com; Phone: + 4021.252.00.57 January and December 2016 were evaluated. Surgery was performed by a single surgeon during his first year of independent practice. The patients were divided into 3 equal groups, each of them including 31 cases. The mean age was 33 years (range 21-43 years). There were 29 female and 64 male patients. Mean follow-up was 11.2 months (range 3 months-19 months). The study group included 19 patients without any associated injury and 74 patients with concurrent meniscal surgery (table 1). Patients with an ACL injury were included in the study. The exclusion criteria were represented by multi-ligament reconstruction, cases using other graft than semitendinosus muscle tendon alone, cartilage surgery and revision cases. Surgery was performed using a high anterolateral and a standard anteromedial portal. Diagnostic arthroscopy was performed to asses the intra-articular lesions. Femoral and tibial tunnels were drilled using an outside-in technique aiming to position the tunnels within the native ACL footprints. The tripled bundled semitendinosus tendon with a minimum thickness of 7mm was used as autograft. Fixation with biodegradable interference srcews, both, on the femur and the tibia was obtained. The tourniquet time was noted for all the patients. A similar evaluation protocol was performed for all patients both preoperatively and at 6 weeks, 3, 6 and 12 months postoperatively. The IKDC Knee Examination Form (IKDC O) was completed by the surgeon. All patients completed the IKDC Subjective Knee Evaluation form (IKDC S), Lysholm Knee Scoring scale and Tegner Activity score. Acomparison regarding tourniquet time and clinical outcomes between cohorts was performed.phic and clinical details Table 1: Table 1 DEMOGRAPHIC DATA