The Swedish National Anterior Cruciate Ligament Register:
A report of baseline variables and outcomes of surgery for almost 18,000

Ahlden M, Samuelsson
K, Sernert N, Forssblad M, Karlson J, and Kartus J. Am J Sports Med. 2012.
[Epub ahead of print]

National registers
for recording medical data are becoming increasingly prevalent. The purpose of
these registers is to compile information on a large number of patients to
detect flaws in surgical procedure, implants, grafts, etc. One such register is
the Swedish National ACLRegister,
which was begun in 2005. The Swedish National ACL Register contains information
on primary reconstructions, revision ACL surgery, and knee reoperations for
other reasons. Using this data, Alden and colleagues set out to report baseline
variables and patient-based outcomes from 2005 through December 2010. The
register is web based and has both a patient (KOOS pre-reconstruction, 1, 2 and
5 years post-surgery) and a surgeon answered section (activity at injury, time
from injury to reconstruction, graft selection, and fixation technique). Also
reported in the registry is any surgical procedures performed on the injured
knee, meniscal surgery, and chondral lesions. Revision or reoperation
procedures performed are reported in the Swedish National ACL Register and are
correlated back to the primary ACL reconstruction procedure. Data for 16,351
ACL reconstruction patients were available. Of those 16,351, KOOS evaluations
were available for 10,473 (64%) preoperatively, 7493 (58%) at 1 year, 5580
(49%) at 2 years, and 1452 (40%) at 5 years. All KOOS scores were significantly
higher at 1, 2, and 5 years after ACL reconstruction. Patients who had 1 or more
concomitant intra-articular injuries had a significantly higher risk of needing
ACL revision surgery. Furthermore, patients who underwent primary ACL
reconstruction scored higher than those who underwent ACL revision surgery. Preoperatively,
patients who would receive a double-bundle reconstruction had significantly
better KOOS scores than those receiving a single-bundle reconstruction. However,
at 1 and 2 year follow up this difference was no longer observable.

Overall this study
presents an interesting look at some factors which are associated with poor
outcomes following ACL reconstruction. While this information can certainly aid
a clinician in advising their patients in an attempt to avoid unwanted
outcomes, it does have the limitation that the Swedish National ACL Register cannot
be used to evaluate best surgical practices as the standard of care changes
more rapidly than it takes to complete long-term studies which evaluate their
efficacy. Perhaps the focus then should be on the rehabilitation pre and post
surgery. If through registries such as the Swedish National ACL Register, we
can identify predictors of successful primary ACL surgery (strength levels,
ROM, edema levels), the rehabilitation could be modified to meet those goals.
This way patients would have to meet certain baseline levels prior to
undergoing surgery, which may then lead to better long-term outcomes and less
revision surgeries. The current study does demonstrate that overall, the
standard of care for ACL ruptures between 2005 and the present does result in
some acceptable level of function for the patient, although without a preinjury
KOOS score, which is not included in this registry, the true level of function
to which the patient returns cannot be determined. Tell us what you think. Do
you think that a registry such as this could aid you in making recommendations for
your patients? Are there other ways that you can see using this information to
influence your clinical practice?

Written by: Kyle
Reviewed by:  Stephen Thomas


Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, & Kartus J (2012). The Swedish national anterior cruciate ligament register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. The American Journal of Sports Medicine, 40 (10), 2230-5 PMID: 22962296