Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction

Abstract

Purpose: To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure.

Methods: A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31.

Results: Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously.

Conclusion: This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner.

Level of evidence: IV, prospective case series.

Keywords: ACL reconstruction; children; outpatient; safety; satisfaction.

Fig. 1

Postoperative anteroposterior (a) and lateral (b) radiographs showing tunnels position and graft fixation devices.

Fig. 2

Flow chart of patient’s itinerary through day surgery anterior cruciate ligament reconstruction (PACU, post-anaesthesia care unit; VAS, visual analogue scale; PSOQ, patient satisfaction outcome questionnaire).FIG. 2 Flow chart of patient’s itinerary through day surgery anterior cruciate ligament reconstruction (PACU, post-anaesthesia care unit; VAS, visual analogue scale; PSOQ, patient satisfaction outcome questionnaire).