Outcomes/Effectiveness Research

Patients who undergo knee ligament reconstruction do better when the doctor or hospital perform it frequently

Reconstruction of the anterior cruciate ligament (ACL) is one of the most common and fastest-growing forms of knee surgery, with 70,547 ACL reconstructions done in New York State alone between 1997 and 2006. However, little has been known about the factors associated with surgical success. According to a new study, the need for hospital readmission for additional treatment was reduced when the initial surgery was done at a hospital or by a doctor that performed high volumes of ACL reconstruction.

Readmission to the hospital within 90 days of the original procedure was not common (2.3 percent of all surgeries). However, 6.5 percent of patients had a subsequent surgery on either knee within a year. Surgeons who performed fewer than 6 ACL reconstructions in the past 12 months (low surgical volume) accounted for 21.7 percent of the procedures. Their patients were 44 percent more likely to be readmitted within 90 days than patients operated on by surgeons who performed at least 52 procedures in the past 12 months (high surgical volume). Similarly, patients operated on at hospitals that performed fewer than 2 ACL reconstructions a month on average were 32 percent more likely to need readmission within 90 days than hospitals averaging more than 10 operations monthly.

Factors associated with poorer outcome were being over 40 years old, being male (higher rates of readmission) or female (higher rates of subsequent ACL reconstruction within 1 year), and having more than one structure injured at the time of the ACL reconstruction. Drawing on a database of all hospital admissions and ambulatory surgeries in New York State, the researchers identified 70,547 ACL reconstructions done in the State between 1997 and 2006. The operations were done by 1,513 surgeons at 263 distinct medical centers. Outpatient surgery (81.4 percent) was more common than inpatient surgery (18.6 percent). Slightly more than a third of the operations (37.3 percent) were for ACL reconstruction only, while more than half (50.6 percent) were ACL reconstruction combined with repair of the meniscus. The study was funded in part by the Agency for Healthcare Research and Quality (HS16075).

More details are in "Epidemiology of anterior cruciate ligament reconstruction," by Stephen Lyman, Ph.D., Panagiotis Koulouvaris, M.D., Seth Sherman, M.D., and others in the October 2009 Journal of Bone and Joint Surgery [American Volume] 91(10), pp. 2321-2328.

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