HSS logoWe reported in a previous article that smaller anterior cruciate ligament (ACL) may be harmful and more vulnerable to injury. Another study on ACL claims that patients who have their anterior cruciate ligament reconstructed may have to undergo another knee surgery if they are women or are treated by a surgeon who apparently performs a low volume of ACL reconstructions.

This study was conducted by scientists at Hospital for Special Surgery. It was apparently discovered that overall, about 6.5% of patients undergoing ACL surgery apparently had to go through 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. This is the largest study to look at factors that may affect subsequent surgeries after ACL reconstruction,” commented, Robert Marx, M.D., an orthopedic surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery.

ACL injuries are apparently pretty general among athletes. Some studies estimate that about 175,000 ACL reconstructions are conducted every year in the United States. The experts have supposedly examined technical aspects of the surgery and results and safety in small groups of patients. At the same time some studies have observed the regularity of reconstruction and following knee surgery in a big population of patients.

The experts at Hospital for Special Surgery took the database from Statewide Planning and Research Cooperative System (SPARCS). The total amount of reconstructions performed between 1997 and 2006 is said to be about 70,547. It was apparently discovered that the incidence of ACL reconstruction supposedly rose from around 6,178 in 1997 to approximately 7,507 in 2006, which is a 21.5% increase.

The experts then trailed how many of these patients supposedly had any subsequent operation within one year or succeeding ACL reconstruction on either knee.

Dr. Marx mentioned, “The SPARCS database lets us look at a very large number of patients with longitudinal followup, so we can see what happens to them as opposed to just what happened during hospital admission. We can follow them for a few years.”

It was discovered that the regularity of subsequent surgery on either knee within one year was said to be 6.5% and the odds of the patients to have succeeding surgery if they were female or treated by a surgeon who performed a low volume of ACL surgeries were supposedly more.

It was seen that about 1.9% of patients who had to undergo ACL reconstruction had a succeeding ACL reconstruction within one year. Patients apparently had more chances to have subsequent reconstruction if they were younger than age 40 and treated at a hospital that conducted a low volume of ACL reconstructions.

Dr. Marx explained, “Younger patients under 40 are at a higher risk and that is likely related to the activity level. This has been my suspicion, but it hasn’t been shown in a population this large before. As we get older, as a group we tend to do less sports and high-risk activities, so people under 40 have a higher risk of needing more ACL surgery.”

Dr. Marx was apparently astonished to find that volume may be a factor which could be attached to the results.

He remarked, “Patients need to understand that younger individuals who undergo an ACL reconstruction have a higher risk of retear. The risk is not the same for all patients. Patients also need to know that being operated on by a lower volume surgeon has a higher risk of reoperation.”

Dr. Marx pointed out that all individuals who tear their ACL are not required to go through reconstruction. A person could be treated non-operatively in a few cases if that individual is not an athlete playing a sport that may involve cutting and pivoting activities liker soccer or basketball.

This study was published in the Journal of Bone and Joint Surgery.