Risk factors for short-term complications of anterior cruciate ligament reconstruction in the United States.
Cvetanovich GL, Chalmers PN, Verma NN, Cole BJ, and Bach BR. Am J Sports Med. 2016. [Epub Ahead of Print].
Take Home Message: Complications following anterior cruciate ligament reconstruction are rare (1.3%). Patients who smoke, have a history of chronic obstructive pulmonary disease, or dyspnea have a greater risk of complications than those that do not.
While anterior cruciate ligament (ACL) reconstruction is a common surgical procedure there is little known about risk factors for post-operative complications. Therefore, Cvetanovich completed a cohort study to determine the incidence of 30-day complications and risk factors for complications after ACL reconstruction. Researchers identified 4,933 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent an ACL reconstruction. All patient records were then analyzed for complications. Complications were deemed to be either major or minor complications. Overall, 66 patients experienced complications (1.3%). Twenty-seven (0.6%) patients had major complications while 43 (0.9%) had minor complications. The most common complications following surgery were symptomatic deep vein thrombosis (0.6%) and return to surgery (0.4%; reasons unknown). Patients with dyspnea (difficulty breathing), who smoke, or who had a history of chronic obstructive pulmonary disease were more likely to have complications. However, the authors noted that other factors (e.g., surgical techniques) likely play a bigger role in determining who will experience post-operative complications.
The data presented in this study are important because it suggests that a patient with a history of smoking, dyspnea, or chronic obstructive pulmonary disease may be more likely to have complications following an ACL reconstruction. Clinicians should educate patients who have these factors about their increased risk of complications. It is important to note that just because these factors are related to a greater risk of complications it does not mean that we can predict who is at risk. The authors noted that there may be a lot of other factors that could influence the risk of complications; for example, surgical technique, variations between facilities, and other patient-related factors. While more research should be completed to confirm the results of this study, clinicians need to educate their patients prior to undergoing surgery about their risk of complications.
Questions for Discussion: Do you educate your patients prior to ACL surgery? If so, do you feel that educating your patients on these predictive factors would affect the patient’s willingness to undergo surgery?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Cvetanovich, G., Chalmers, P., Verma, N., Cole, B., & Bach, B. (2016). Risk Factors for Short-term Complications of Anterior Cruciate Ligament Reconstruction in the United States The American Journal of Sports Medicine, 44 (3), 618-624 DOI: 10.1177/0363546515622414