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) injury prevention programs are effective in the short term, but lack effectiveness in the long term (Benjaminse, Gokeler, et al., 2015). There is a need for optimization of current ACL injury prevention programs considering the relatively large number of subjects needed to treat (Lyman et al., 2009) and associated time investment of training staff (McGlashan & Finch, 2010). Most ACL injury prevention programs use verbal instructions directed towards specific knowledge of body movements (Irmischer et al., 2004; Myklebust et al., 2003; Pfeiffer, Shea, Roberts, Grandstrand, & Bond, 2006). "
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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.
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