Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry

Abstract

Background: Orthopaedic registries have shown value in tracking and surveillance of patients, implants, and outcomes associated with procedures. No current anterior cruciate ligament reconstruction registry (ACLRR) exists in the United States.

Purpose: To describe the current cohort captured by an institutional ACLRR and describe the outcomes observed in the registered patients and how findings from the ACLRR are disseminated.

Study design: Cohort study; Level of evidence, 2.

Methods: The anterior cruciate ligament reconstructions (ACLRs) registered between February 2005 and September 2011 by 244 surgeons in 48 medical centers were evaluated. The ACLRR collected data intra- and postoperatively using paper forms and electronic medical records. The ACLRR cohort was longitudinally followed and outcomes were prospectively ascertained. Outcomes (ie, revisions, subsequent operations, venous thromboembolism, and surgical site infections) were adjudicated via chart review. Descriptive statistics are used to describe the cohort and Kaplan-Meier curves to evaluate survival.

Results: During the study period, 16,192 ACLRs (15,101 primary and 1091 revisions) with a median follow-up of 1.6 years (interquartile range, 0.7-2.8 years) were registered. Male patients received 64% of both primary and revision ACLRs. The mean age at surgery was 29.5 years (SD, 11.4 years) for primary and revision reconstructions. Cartilage injuries were noted in 25.2% of primary and 37.5% of revision ACLRs, and meniscal injuries were identified in 60.8% and 53.2%, respectively. Autografts were used in 57.6% of primary ACLRs and 20.9% of revisions. Allografts were used in 42.4% of primaries and 78.8% of revisions. In primary ACLR, the most common femoral and tibial fixation types were interference screws (42.2% and 79.7%, respectively). Fixation type distribution was nearly identical in primaries and revisions. Of the primary ACLRs, 3.7% had subsequent operations on the same knee and 1.7% on the contralateral knee. Deep surgical site infection developed in 0.3% of primaries and 0.8% of revisions. Symptomatic deep vein thromboses were seen in 0.2% of both primaries and revisions. The overall revision rate was 1.7%. Lower rates of graft survival were identified in younger patients and those with allografts.

Conclusion: Large, community-based ACLRRs are useful in informing participating surgeons of current treatment practices, prevalence of concurrent injuries, and outcomes associated with the procedures. Information from the ACLRR can be used to develop interactive patient and surgeon tools that can be used to optimize patient care.

Keywords: ACL reconstruction registry; anterior cruciate ligament reconstruction; graft; ligament registry.