Application and Surgical Technique of ACL Reconstruction Using Worldwide Registry Datasets: What Can We Extract?

Abstract

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. The purpose of this study was to compare surgical reconstruction of the ACL between different countries and regions in order to describe differences regarding epidemiological data, reconstruction frequency, and graft choice. A systematic literature search was performed using the ACL study group website in order to identify the relevant knee ligament registers. Four national registries were included, comprising those from Sweden, the UK, New Zealand, and Norway. A large variation was found concerning the total number of primary ACL reconstructions with a reported range from 4.1 to 51.3 per 100,000 inhabitants. The country-specific delay between injury and reconstruction varied between an average of 6.0 months and 17.6 months. The leading sports activities resulting in ACL injury included soccer, alpine skiing, handball, rugby, and netball. Moreover, a strong variability in graft choice for primary reconstruction was found. The comparison of ACL registers revealed large differences, indicating different clinical implications regarding conservative or surgical therapy and choice of the preferable graft. ACL registers offer a real-world clinical perspective with the aim to improve quality and patient safety by investigating factors associated with subsequent surgical outcomes.

High revision arthroscopy rate after ACL reconstruction in men's professional team sports

“…Current scientific studies on the choice of grafts or concomitant injury patterns are predominantly based on general ACL registry data [15, 27] but are not focused on professional sports populations. Conclusions about surgical treatment strategies for ACL injuries cannot be transferred from the general population to professional athletes [58, 63]. Furthermore, currently available scientific ACL reports in team sports often lack detailed information about surgical techniques, concomitant injuries and the resulting short‐term complications, revision and re‐injury rates [33, 36, 61, 62].…”

Allografts in soft-tissue knee surgery

“…20 This is compared to 0% to 2% in the other data registries mentioned. 52 Of these databases, only the Kaiser Permanente database attempts to collect data on processing of the graft, albeit without data on storage or other factors affecting graft integrity. The other registries do not collect this data and therefore there is not enough detail to sensitively analyze differences in outcomes between allografts and autografts.…”

Scoping Review on ACL Surgery and Registry Data

“…Currently, there are seven ACL registers around the world including national ACL registries in Denmark, Luxembourg, New Zealand, Norway, Sweden, United Kingdom (UK), and a regional-based registry in the United States (US) (Table 1 ). These ACL registries have allowed possibilities to determine appropriate treatment types as well as identifying essential factors for improving treatment of ACL injuries [ 1 ]. Furthermore, identification of failures, including revisions and reoperations, and PROMs have provided a possibility for continuous evaluation of clinical practice and thus contributed to improvements in treatment planning of ACL injuries.…”

“…Although several randomized controlled trials (RCTs) and registry-based studies on patients with ACL injury have been published, the knowledge on the optimal type of treatment, including the timing of surgery, choice of graft type, and treatment of other concomitant injuries, is still lacking. National and regional ACL registries containing a large amount of data have provided the opportunity to increase our understanding of ACL injuries and their treatment [1,2]. At date, there are several ongoing projects based on various ACL registries aiming to determine how to optimize treatment and pre-and postoperative rehabilitation and improve patient-related outcome measures (PROMs), as well as identifying risk factors for a second ACL injury.…”