Epidemiology of Anterior Cruciate Ligament Reconstruction: Trends, Readmissions, and Subsequent Knee Surgery

Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 10/2009; 91(10):2321-8. DOI: 10.2106/JBJS.H.00539
Source: PubMed


Anterior cruciate ligament reconstruction is widely accepted as the treatment of choice for individuals with functional instability due to anterior cruciate deficiency. There remains little information on the epidemiology of anterior cruciate ligament reconstruction with regard to adverse outcomes such as hospital readmission and subsequent knee surgery. We sought to identify the frequency of anterior cruciate ligament reconstruction, the rates of subsequent operations and readmissions, and potential predictors of these outcomes.
The Statewide Planning and Research Cooperative System (SPARCS) database, a census of all hospital admissions and ambulatory surgery in New York State, was used to identify anterior cruciate ligament reconstructions performed between 1997 and 2006. Patients with concomitant pathological conditions of the knee were included. The patients were tracked for hospital readmission within ninety days after the surgery and for subsequent surgery on either knee within one year. The risks of these outcomes were modeled with use of age, sex, comorbidity, hospital and surgeon volume, and inpatient or outpatient surgery as potential risk factors.
We identified 70,547 anterior cruciate ligament reconstructions, with an increase from 6178 in 1997 to 7507 in 2006. Readmission within ninety days after the surgery was infrequent (a 2.3% rate), but subsequent surgery on either knee within one year was much more common (a 6.5% rate). Patients were at increased risk for readmission within ninety days if they were over forty years of age, sicker (e.g., had a preexisting comorbidity), male, and operated on by a lower-volume surgeon. Predictors of subsequent knee surgery included being female, having concomitant knee surgery, and being operated on by a lower-volume surgeon. Predictors of a subsequent anterior cruciate ligament reconstruction included an age of less than forty years, concomitant meniscectomy or other knee surgery, and surgery in a lower-volume hospital.
The rate of anterior cruciate ligament reconstruction has increased in frequency. Also, while anterior cruciate ligament reconstruction appears to be a safe procedure, the risk of a subsequent operation on either knee is increased among younger patients and those treated by a lower-volume surgeon or at a lower-volume hospital.

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Available from: Seth L Sherman, Feb 09, 2015
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    • "Anterior cruciate ligament (ACL) rupture is a common injury among active individuals which involves approximately 20% of all sports-related knee injuries [1], with estimates of injury exceeding 100,000 annually [2] [3]. Patients who experience knee instability which prevents them from performing jumping and cutting maneuvers undergo arthroscopically assisted reconstructive surgery using a hamstring or patellabone-tendon-bone auto-graft [4]. "
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    ABSTRACT: BACKGROUND: The single-leg squat (SLS) is a common strengthening exercise after anterior cruciate ligament reconstruction (ACLR) surgery. The multi-joint nature of squatting may allow patients to shift the demand from the target muscle group to its synergies, thus reducing the strengthening effect of the SLS exercise. OBJECTIVE: To compare the muscular contribution in the involved and uninvolved side of the ACLR patients and both sides of the ACLR patients with the matched control group during SLS exercise. METHOD: Seventeen athletic men with unilateral ACL reconstruction and 16 athletic healthy men participated. Integrated Electromyography was used to calculate the relative contributions of, Vastus Medialis (VM), Vastus Lateralis (VL), rectus femoris (RF), Gluteus maximus (GMax) and Soleus (SOL) muscles to SLS performance and squat peak force was measured with a Biodex System 3 isokinetic dynamometer. RESULTS: The VM muscle contribution was significantly lower and the VL and GMax contribution was higher on the involved side of the ACLR patients compared to their uninvolved side and the control group. The SLS peak force was significantly lower on the involved side compared to the uninvolved side. CONCLUSION: The increased VL and GMax muscle contribution might be a compensatory mechanism for the reduced VM contribution on the involved side.
    Isokinetics and exercise science 01/2014; 22(4):343-349. DOI:10.3233/IES-140556 · 0.49 Impact Factor
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    • "annually in the United States [1]. With the direct cost of an ACL surgery being at least $11,900 in the United States [2], the financial impact of ACL reconstruction is estimated to exceed $2 billion per year. "
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    ABSTRACT: An imaging software system was studied for improving the performance of ACL reconstruction which requires identifying ACL insertion sites for bone tunnel placement. This software predicts and displays the insertion sites based on the literature data and patient-specific bony landmarks. Twenty orthopaedic surgeons performed simulated arthroscopic ACL surgeries on 20 knee specimens, first without and then with the visual guidance by fluoroscopic imaging, and their tunnel entry positions were recorded. The native ACL insertion morphologies of individual specimens were quantified in relation to CT-based bone models and then used to evaluate the software-generated insertion locations. Results suggested that the system was effective in leading surgeons to predetermined locations while the application of averaged insertion morphological information in individual surgeries can be susceptible to inaccuracy and uncertainty. Implications on challenges associated with developing engineering solutions to aid in re-creating or recognizing anatomy in surgical care delivery are discussed.
    Journal of Healthcare Engineering 09/2012; 3(3):443-453. DOI:10.1260/2040-2295.3.3.443 · 0.75 Impact Factor
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    • "Unfortunately, those techniques have not been tested in a large number of subjects and are technically challenging21-24). Considering that the prevalence of complications of physeal injury is very low15-18) and experienced surgeons produce more satisfactory results compared to the inexperienced25), we believe that transphyseal reconstruction is a relatively safe and promising surgical procedure for ACL tears. "
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    ABSTRACT: In anterior cruciate ligament (ACL) injury, conventional adult reconstruction techniques have to face the potential risk of growth disturbance or angular deformities in skeletally immature patients. The aim of this study was to evaluate the clinical outcomes of ACL reconstruction by conventional transphyseal tunnel technique. On a retrospective basis, we reviewed 25 skeletally immature patients; all the patients showed skeletal maturity at last follow-up, and the mean age was 16.4 years. The average injury to surgery interval was 12.6 months. Clinical outcomes were assessed at a mean of 74.4 months postoperatively using the Lysholm Knee Scoring Scale, the Tegner activity level, the International Knee Documentation Committee (IKDC), and plain radiographs. All the patients had undergone transphyseal reconstruction of ACL. The mean Lysholm score was 48.36 points preoperatively and 93.32 points postoperatively; the mean Tegner activity level was changed from 3.0 points to 5.6 points. The mean IKDC level was categorized as C preoperatively and changed to A postoperatively. Our midterm outcome at an average 6 years after surgery was satisfactory without significant leg length discrepancies or abnormal alignment of the knee joint. Transphyseal reconstruction of ACL is a good treatment modality in the skeletally immature patient.
    09/2012; 24(3):173-9. DOI:10.5792/ksrr.2012.24.3.173
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