Patients who have their anterior cruciate ligament (ACL) reconstructed are more likely to have subsequent knee surgery if they are women or are treated by a surgeon who does a low volume of ACL reconstructions, according to a study in the October 2009 TK issue of The Journal of Bone and Joint Surgery. The study, conducted by investigators at Hospital for Special Surgery, also found that overall, 6.5% of patients undergoing ACL surgery had to undergo another knee operation within one year.
“It is a small minority of patients who need further surgery early on, but that is a lot of trips back to the operating room considering how much surgery is done,” said Robert Marx, M.D., an orthopedic surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery. “This is the largest study to look at factors that may affect subsequent surgeries after ACL reconstruction.”
ACL injuries are common in athletes. Some studies estimate that as many as 175,000 ACL reconstructions are done each year in the United States. While investigators have studied technical aspects of the surgery and outcomes and safety in small groups of patients, few studies have examined the frequency of reconstruction and subsequent knee surgery in a large population of patients.
To remedy this, researchers at Hospital for Special Surgery turned to the Statewide Planning and Research Cooperative System (SPARCS) database. This database run by the New York State Department of Health provides a census of all hospital admissions and ambulatory procedures within the state of New York. Investigators identified all ACL reconstructions performed between 1997 and 2006; the total was 70,547. They found that the frequency of ACL reconstruction increased from 6,178 in 1997 to 7,507 in 2006, a 21.5% increase. “The rate of ACL surgery went up dramatically during the study period,” said Dr. Marx.
