The Journal of Bone and Joint Surgery (American). 2009;91:2321-2328.
doi:10.2106/JBJS.H.00539
© 2009 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Google Scholar
Right arrow Articles by Lyman, S.
Right arrow Articles by Marx, R. G.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lyman, S.
Right arrow Articles by Marx, R. G.
Related Collections
Right arrow Sports
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Epidemiology of Anterior Cruciate Ligament Reconstruction

Trends, Readmissions, and Subsequent Knee Surgery

Stephen Lyman, PhD1, Panagiotis Koulouvaris, MD1, Seth Sherman, MD1, Huong Do, MA1, Lisa A. Mandl, MD, MPH1 and Robert G. Marx, MD, MSc, FRCSC1

1 Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for S. Lyman: lymans{at}hss.edu

Investigation performed at the Foster Center for Clinical Outcome Research, Hospital for Special Surgery, New York, NY

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from The Weill-Cornell/Hospital for Special Surgery Center for Education and Research in Therapeutics Grant from the Agency for Healthcare Research and Quality (U18HS016075). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?