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Lucocq J, Khalil M, Roberts L, Dalgleish S, Jariwala A. Improving day surgery rates of anterior cruciate ligament reconstruction surgery in surgical units not dedicated to performing day surgery: A retrospective observational cohort study. J Eval Clin Pract 2021; 27:1321-1325. [PMID: 33709465 DOI: 10.1111/jep.13558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Current guidance advises that at least 90% of anterior cruciate ligament reconstructions are performed as day-case operations. Same-day surgery rates achieved by surgical units have significant clinical and financial implications. The primary aim of this multi-centre study was to determine the rate of admission and causes for admissions in patients undergoing anterior cruciate ligament reconstruction. METHOD Patient documentations were studied for those who underwent an elective anterior cruciate ligament reconstruction between January 2015 and April 2019. Contributing factors related to admission length were investigated and included patient age, gender, body mass index (BMI), operating surgeon, operating hospital, American Society of Anaesthesiology (ASA) grade, and position of the patient on the operating list. Both univariate and multivariate analysis were conducted using the STATA/IC 16.1 statistical package. RESULTS The day surgery rate of anterior cruciate ligament reconstructions were 52% (50/95). Patients positioned later on the operating list were more likely to be admitted post-operatively (OR, 4.49; P = .002; 95% CI, 1.72-11.69) and this was the only factor associated with admission. A large majority of admitted patients (95.6%) were admitted without a clinical cause and were otherwise safe for same-day discharge. CONCLUSIONS The day surgery rate for ACL reconstruction remains low, despite an extremely low complication rate. Reconfiguration of the operating lists and positioning anterior cruciate ligament reconstructions earlier in the day will likely increase the same-day discharge rate and reduce associated costs.
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Affiliation(s)
- James Lucocq
- University Department of Trauma and Orthopaedic Surgery (UDOTS), Ninewells Hospital, Dundee, DD2 1UB, Dundee, Scotland.,University of Dundee, Dundee, Scotland
| | - Mostafa Khalil
- University Department of Trauma and Orthopaedic Surgery (UDOTS), Ninewells Hospital, Dundee, DD2 1UB, Dundee, Scotland
| | - Louise Roberts
- University Department of Trauma and Orthopaedic Surgery (UDOTS), Ninewells Hospital, Dundee, DD2 1UB, Dundee, Scotland
| | - Stephen Dalgleish
- University Department of Trauma and Orthopaedic Surgery (UDOTS), Ninewells Hospital, Dundee, DD2 1UB, Dundee, Scotland
| | - Arpit Jariwala
- University Department of Trauma and Orthopaedic Surgery (UDOTS), Ninewells Hospital, Dundee, DD2 1UB, Dundee, Scotland.,University of Dundee, Dundee, Scotland
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Cost Comparison of Surgically Treated Ankle Fractures Managed in an Inpatient Versus Outpatient Setting. J Am Acad Orthop Surg 2019; 27:e127-e134. [PMID: 30192248 DOI: 10.5435/jaaos-d-16-00897] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although choices physicians make profoundly affect the cost of health care, few surgeons know relative costs associated with the setting in which care is provided. Without valid cost information, surgeons cannot understand how their choices affect the total cost of care. METHODS Actual costs for all isolated, surgically treated ankle fractures at a level I trauma hospital and affiliated outpatient surgery center were determined using a validated episode of care costing system and analyzed using multivariate regression analysis in this retrospective cohort study. RESULTS One hundred forty-eight patients (ie, 61 inpatients and 87 outpatients) with isolated, surgically treated ankle fractures were included. After controlling for confounding variables, outpatient care was associated with 31.6% lower costs compared with inpatient care. Obese patients had 21.6% higher costs compared with patients who were not obese. No difference was noted in revision surgery, readmission, or return visits to the emergency department for patients treated on an inpatient or outpatient basis. CONCLUSION Where medically/socially appropriate, this analysis suggests that ankle fracture surgery should be provided in an outpatient surgical facility to provide the greatest value to the patient and society. LEVEL OF EVIDENCE Level III.
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Dedicated peri-operative pathway improved day case discharge rate for anterior cruciate ligament reconstructions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:639-644. [PMID: 30390166 DOI: 10.1007/s00590-018-2326-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
The authors proposed that a well-developed peri-operative pathway for anterior cruciate ligament (ACL) reconstructions improve day case discharge rate with high patient satisfaction. A prospective observational study was undertaken at a district general hospital in UK between August 2017 and April 2018. A dedicated multidisciplinary peri-operative pathway was developed and introduced in January 2018. All primary ACL reconstructions using hamstring grafts in adult patients were included. Primary outcome measure was day case discharge and secondary outcome measures were visual analogue score for pain (VASP), nausea and vomiting scale (NVS), patient satisfaction and 30-day readmission. Patients who underwent surgery before and after introduction of the pathway were in group 1 and group 2, respectively. There were 19 and 22 patients each in group 1 and 2. Age and gender were similar in both groups. Day case discharge rate was significantly better in group 2 (68.4% vs 95.5%, p = 0.02). There were no significant differences in VASP or NVS on day 0, 1 or 3. Patient satisfaction rates were better in group 2 (85.7% vs 100%, p = 0.13). There were no readmissions in both groups. The VASP on day 1 and day 3 post-operatively was significantly better in those who were discharged on the same day (66.8 vs 41.3, p = 0.02; 60.5 vs 34.9, p = 0.03). A well-developed dedicated peri-operative pathway improved day case discharge rate for ACL reconstructions. The pathway was safe and had a higher patient satisfaction rate.
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Ferrari D, Lopes TJA, França PFA, Azevedo FM, Pappas E. Outpatient versus inpatient anterior cruciate ligament reconstruction: A systematic review with meta-analysis. Knee 2017; 24:197-206. [PMID: 28117216 DOI: 10.1016/j.knee.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Efforts to reduce the financial costs related to anterior cruciate ligament reconstruction (ACLR) include reducing the length of hospitalization of the patient undergoing ACLR. However, it is unclear if inpatient and outpatient ACLR differ in terms of safety, satisfaction, costs and clinical outcomes. AIM To systematically review and synthesize the literature that directly compared costs and outcomes after outpatient and inpatient ACLR. METHODS Studies that directly compared outcomes of inpatient and outpatient ACLR were retrieved via searches in MEDLINE, EMBASE, CINAHL, AMED, Cochrane, SPORTDiscus, Web of Science and SCOPUS databases. Random effects meta-analysis and descriptive analysis were performed for relevant outcomes. RESULTS Costs analysis suggests that outpatient ACLR may be a cost effective procedure with savings ranging from $1371 to $7390. There were no differences for systemic and local complications p=0.64 (odds ratio 1.65, 95% confidence interval 0.20 to 13.49) and p=0.72 (0.81, 0.26 to 2.56) respectively, or pain in the second and seventh days after surgery, p=0.78 (mean difference -0.16; 95% confidence interval -1.28 to 0.96) and p=0.44 (0.48, -0.75 to 1.71), respectively. However, the outpatient group had less pain than the inpatient group in the first and third days after surgery, p=0.0001 (-0.39, -0.57 to -0.21) and p=0.0001(-0.39, -0.39 to -0.20), respectively. Descriptive analysis revealed that the outpatient group experienced similar or better satisfaction, strength and knee function compared to the inpatient group. CONCLUSION AND KEY FINDINGS Complications, pain, satisfaction, knee function and strength are similar or better after outpatient compared to inpatient ACLR. Furthermore, cost savings may be achieved with outpatient ACLR. However, included studies presented low methodological quality and the quality of evidence was very low, so these results need to be confirmed by future studies. REGISTRATION NUMBER PROSPERO (CRD42015024990).
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Affiliation(s)
- Deisi Ferrari
- University of São Paulo, Post-Graduation Program Interunits Bioengineering EESC/FMRP/IQSC-USP, São Carlos, Brazil; CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70.040-020, Brazil.
| | - Thiago J A Lopes
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Research Laboratory of Exercise Science, The Brazilian Navy, Rio de Janeiro, Brazil.
| | - Paulo F A França
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
| | - Fábio M Azevedo
- University of São Paulo State, School of Science and Technology, Physical Therapy Department, Presidente Prudente, Brazil.
| | - Evangelos Pappas
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
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Saltzman BM, Cvetanovich GL, Nwachukwu BU, Mall NA, Bush-Joseph CA, Bach BR. Economic Analyses in Anterior Cruciate Ligament Reconstruction: A Qualitative and Systematic Review. Am J Sports Med 2016; 44:1329-35. [PMID: 25930672 DOI: 10.1177/0363546515581470] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As the health care system in the United States (US) transitions toward value-based care, there is an increased emphasis on understanding the cost drivers and high-value procedures within orthopaedics. To date, there has been no systematic review of the economic literature on anterior cruciate ligament reconstruction (ACLR). PURPOSE To evaluate the overall evidence base for economic studies published on ACLR in the orthopaedic literature. Data available on the economics of ACLR are summarized and cost drivers associated with the procedure are identified. STUDY DESIGN Systematic review. METHODS All economic studies (including US-based and non-US-based) published between inception of the MEDLINE database and October 3, 2014, were identified. Given the heterogeneity of the existing evidence base, a qualitative, descriptive approach was used to assess the collective results from the economic studies on ACLR. When applicable, comparisons were made for the following cost-related variables associated with the procedure for economic implications: outpatient versus inpatient surgery (or outpatient vs overnight hospital stay vs >1-night stay); bone-patellar tendon-bone (BPTB) graft versus hamstring (HS) graft source; autograft versus allograft source; staged unilateral ACLR versus bilateral ACLR in a single setting; single- versus double-bundle technique; ACLR versus nonoperative treatment; and other unique comparisons reported in single studies, including computer-assisted navigation surgery (CANS) versus traditional surgery, early versus delayed ACLR, single- versus double-incision technique, and finally the costs of ACLR without comparison of variables. RESULTS A total of 24 studies were identified and included; of these, 17 included studies were cost identification studies. The remaining 7 studies were cost utility analyses that used economic models to investigate the effect of variables such as the cost of allograft tissue, fixation devices, and physical therapy, the percentage and timing of revision surgery, and the cost of revision surgery. Of the 24 studies, there were 3 studies with level 1 evidence, 8 with level 2 evidence, 6 with level 3 evidence, and 7 with level 4 evidence. The following economic comparisons were demonstrated: (1) ACLR is more cost-effective than nonoperative treatment with rehabilitation only (per 3 cost utility analyses); (2) autograft use had lower total costs than allograft use, with operating room supply costs and allograft costs most significant (per 5 cost identification studies and 1 cost utility analysis); (3) results on hamstring versus BPTB graft source are conflicting (per 2 cost identification studies); (4) there is significant cost reduction with an outpatient versus inpatient setting (per 5 studies using cost identification analyses); (5) bilateral ACLR is more cost efficient than 2 unilateral ACLRs in separate settings (per 2 cost identification studies); (6) there are lower costs with similarly successful outcomes between single- and double-bundle technique (per 3 cost identification studies and 2 cost utility analyses). CONCLUSION Results from this review suggest that early single-bundle, single (endoscopic)-incision outpatient ACLR using either BPTB or HS autograft provides the most value. In the setting of bilateral ACL rupture, single-setting bilateral ACLR is more cost-effective than staged unilateral ACLR. Procedures using CANS technology do not yet yield results that are superior to the results of a standard surgical procedure, and CANS has substantially greater costs.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nathan A Mall
- St Louis Center for Cartilage Restoration and Repair Sports Medicine, St Louis, Missouri, USA
| | - Charles A Bush-Joseph
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Andrés-Cano P, Godino M, Vides M, Guerado E. Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Andrés-Cano P, Godino M, Vides M, Guerado E. Complicaciones de la reparación artroscópica del ligamento cruzado anterior sin ingreso hospitalario. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:157-64. [DOI: 10.1016/j.recot.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/23/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022] Open
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Khan T, Jackson WF, Beard DJ, Marfin A, Ahmad M, Spacie R, Jones R, Howes S, Barker K, Price AJ. The use of standard operating procedures in day case anterior cruciate ligament reconstruction. Knee 2012; 19:464-8. [PMID: 21646025 DOI: 10.1016/j.knee.2011.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 02/02/2023]
Abstract
The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs.
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Affiliation(s)
- T Khan
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK
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Tompkins M, Plante M, Monchik K, Fleming B, Fadale P. The use of a non-benzodiazepine hypnotic sleep-aid (Zolpidem) in patients undergoing ACL reconstruction: a randomized controlled clinical trial. Knee Surg Sports Traumatol Arthrosc 2011; 19:787-91. [PMID: 21253706 DOI: 10.1007/s00167-010-1368-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 12/13/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Previous studies have addressed post-operative pain management after ACL reconstruction by examining the use of intra-articular analgesia and/or modification of anesthesia techniques. To our knowledge, however, no previous studies have evaluated the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction. The purpose of this prospective, blinded, randomized, controlled clinical study was to evaluate the effect of zolpidem on post-operative narcotic requirements, pain, and fatigue in patients undergoing outpatient arthroscopic ACL reconstruction. METHODS Twenty-nine patients undergoing arthroscopic ACL reconstruction were randomized to a treatment group or placebo group. Both groups received post-operative hydrocodone/acetaminophen bitartrate (Vicodin ES). Patients in the treatment group received a single dose of zolpidem for the first seven post-operative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem. The amount of Vicodin used in each group, the amount of post-operative pain, and the amount of post-operative fatigue were analyzed. RESULTS Following ACL reconstruction, a 28% reduction was seen in the total amount of narcotic consumed with zolpidem (P = 0.047) when compared to placebo. There were no significant differences in post-operative pain or fatigue levels between zolpidem and placebo. CONCLUSION Adding zolpidem to the post-operative medication regimen after arthroscopic ACL reconstruction helps to lower the amount of narcotic pain medication required for adequate analgesia. LEVEL OF EVIDENCE Randomized controlled clinical trial, Level I.
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Affiliation(s)
- Marc Tompkins
- Department of Orthopaedics, Alpert Brown Medical School/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
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Cost analysis of outpatient anterior cruciate ligament reconstruction: autograft versus allograft. Clin Orthop Relat Res 2010; 468:1418-22. [PMID: 20020337 PMCID: PMC2853669 DOI: 10.1007/s11999-009-1178-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 11/12/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior studies suggest the cost of allograft anterior cruciate ligament (ACL) reconstruction is less than that for autograft reconstruction. Charges in these studies were influenced by patients requiring inpatient hospitalization. QUESTION/PURPOSE: We therefore determined if allograft ACL reconstruction would still be less costly if all procedures were performed in a completely outpatient setting. METHODS We retrospectively reviewed 155 patients who underwent ACL reconstruction in an ambulatory surgery center between 2001 and 2004; 105 had an autograft and 50 had an allograft. Charges were extracted from itemized billing records, standardized to eliminate cost increases, and categorized for comparison. Surgeon and anesthesiologist fees were not included in the analysis. Groups were compared for age, gender, mean total cost, mean cost of implants, and several other cost categories. RESULTS The mean total cost was $5465 for allograft ACL reconstruction and $4872 for autograft ACL reconstruction. There were no differences in complications between the two groups. CONCLUSIONS Allograft ACL reconstruction was more costly than autograft ACL reconstruction in the outpatient setting. The cost of the allograft outweighs the increased surgical time needed for harvesting an autograft. LEVEL OF EVIDENCE Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
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Abstract
PURPOSE Understanding patients' experiences of their interactions with health services is an important step in building quality from within. The purpose of this article is to look at the possibilities for involving service users in the development of the National Health Service in England through the structure of integrated care pathways (ICPs). DESIGN/METHODOLOGY/APPROACH A systematic literature review was undertaken to identify how patient experiences have been attained and used in three clinical areas: cataract care, hip replacement and knee arthroscopy. The information was weighted according to methodological criteria and synthesized according to the typical stages of each pathway. Key issues were summarised thematically across each pathway. FINDINGS The findings relate to the use of patient views and experiences within organisational structures, service development, methodological research, education and training. The article identifies important issues of practical significance for involving service users in the planning and development of patient focused ICPs: such as the diversity of patients, perspectives of continuity, information and patient support and the need for methodological research. RESEARCH LIMITATIONS/IMPLICATIONS The review is limited in that the literature across all three pathways tends to report findings of small studies undertaken in one clinical service or setting and most studies are not randomised or controlled. ORIGINALITY/VALUE The literature identified by the review contains important messages for both NHS policy and future research to involve service users in the planned expansion and plurality of NHS care.
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Nikolić D, Drasković V, Vulović R. [Reconstruction of the anterior cruciate ligament of the knee]. VOJNOSANIT PREGL 2006; 63:945-51. [PMID: 17144429 DOI: 10.2298/vsp0611945n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Numerous papers on reconstruction of the anterior cruciate ligament of the knee (ACL) contribute to the significance of this method. The aim of this study was to analyze the outcome of the use of this surgical treatment method regardless the type of surgical intervention, graft, and the choice of the material for fixing. METHODS The study included 324 patients treated within the period from April 1997 to April 2004. Arthroscopically assisted ACL reconstruction was typically performed using the central one-third of the patellar ligament, as a graft, with bone blocks. Fixing was performed using screws (spongy or interferential, Mitek type). In the cases who required revision of the surgery, we used a graft m. semitendinosus and m. gracilise (STG) or a graft of the patellar ligament (B-Pt-B). Fixation in these cases was performed using absorptive wedges according to the Rigidfix technique or metallic implants. RESULTS The analysis included the results of the reconstruction of the anterior cruciate ligament of the knee (B-Pt-B or STG graft) in 139 of the knees. Chronic injuries were revealed in 132 (94.9%) of the knees. According to the anamnesis and clinical findings, the feeling of instability prevailed in 132 (94.9%) of the knees, pain in 72 (51.7%), effluents in 24 (17.2%), and blockages in 13 (9.3%). Early and late postoperative complications were noticeable in 3.5% each. Hypotrophy of the upper knee musculature up to 2 cm was present in 53.9% of the operated knees, while minor contractions in 13.6% of them. The final result of the reconstruction graded begusing the Lysholm Scale was 85.2, simultaneous reconstructions of other ligaments 75.3, and revision surgery 68.0. First-grade degenerative postoperative changes according to the K/L Scale were found in 55.0% of the surgically treated knees, while the worst, four-grade one in 2.5%. CONCLUSION On the basis of these findings, we can conclude that this method is the method of choice in preventing further "worsening" of the chronically instable knee. The surgical technique of choice is arthroscopically assisted reconstruction using a B-Pt-B or STG graft.
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Affiliation(s)
- Dragan Nikolić
- Vojnomedicinska akademija, Klinika za traumatologiju i ortopediju, Beograd, Srbija.
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Shaw AD, DiBartolo G, Clatworthy M. Daystay hamstring ACL reconstruction performed under regional anaesthesia. Knee 2005; 12:271-3. [PMID: 16026696 DOI: 10.1016/j.knee.2004.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Accepted: 05/24/2004] [Indexed: 02/02/2023]
Abstract
Daycase ACL reconstruction is commonly performed under general anaesthesia with a patella tendon graft. We report our experience with hamstring reconstruction under regional anaesthesia. Over a 14-month period, 104 daycase arthroscopic ACL reconstructions were performed by one surgeon and one anaesthetist. All operations were performed under spinal anaesthesia with a femoral nerve block. Patients were discharged with oral analgesia, brace and a cryocuff. One hundred and two patients were prospectively evaluated with a visual analogue pain score (0-10) and a patient satisfaction questionnaire. Of these 102 patients, 101 (99%) were happy to be discharged on the same day. One patient was admitted from the daycase unit, and one patient was re-admitted. Patients were very satisfied with the pain relief provided. The mean visual analogue pain score was 1.0 at discharge, 1.8 in the middle of the first night, and 2.1 on the first post-op day. Patients experienced significantly more pain the day after surgery than the evening of surgery (p=0.04). We conclude that hamstring ACL reconstruction under regional anaesthesia is well tolerated by patients as a daycase procedure.
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Affiliation(s)
- A D Shaw
- Department of Orthopaedic Surgery, Victoria Infirmary, Langside Road, Glasgow G42, United Kingdom.
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Cirugía del ligamento cruzado anterior sin ingreso hospitalario. Rev Esp Cir Ortop Traumatol (Engl Ed) 2004. [DOI: 10.1016/s1888-4415(04)76249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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