Outcomes of ACL Reconstruction in Patients with Diabetes

Abstract

Purpose Diabetes has been associated with adverse outcomes following various types of surgery. There is no previously published data regarding the impact of diabetes on outcomes from anterior cruciate ligament (ACL) reconstruction (ACLR). The purpose of this study was to test the hypotheses that diabetes is associated with worse clinical outcomes and a higher prevalence of subsequent surgeries following ACLR. Methods ACL deficient patients (n=2198) undergoing unilateral ACLR from a multicenter prospective study were included. Patients who self-reported diabetes based on comorbidity questions prior to surgery were identified from the database. They were compared with the remainder of the cohort who did not self-report diabetes. All patients were followed up for a minimum of 2 years following their index surgery. Minimum 2 year follow-up was attained on 1905/2198 (87%) via completed outcome questionnaires and 2096/2198 (95%) regarding subsequent surgery. The primary outcome measures were three validated outcome instruments. Secondary outcome measure was the incidence of additional surgery on the ipsilateral and contralateral knees. Results Patients with diabetes had significantly higher activity level at 2 years (OR=2.96; 95% CI=1.30–6.77; p=0.01), but otherwise slightly worse clinical outcomes, compared to patients without diabetes (OR range = 0.42–0.59). The prevalence of subsequent surgeries in patients with diabetes was not significantly different from the prevalence in patients without diabetes. Conclusions Patients with diabetes maintain a higher activity level after ACLR despite slightly lower patient reported outcomes scores compared to patients without diabetes and do not have a higher rate of subsequent surgery.

Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL) Tear after ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions

“…Finally, the remaining demographics and comorbidities failed to show any association with contralateral ACLR, including obesity or morbid obesity, type 1 or type 2 diabetes, and a history of anxiety. This is in agreement with other studies that have also shown no significant association between these factors and graft failure or contralateral ACLR [3, 6]. Some authors have suggested that patients with an elevated BMI and diabetes may be less active after ACLR and therefore at reduced risk of contralateral injury [6].…”

Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction

“…Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopaedic procedures [14, 22]. Both short‐ and long‐term clinical outcomes after ACLR have been well characterized [3, 7, 11, 15, 17, 23, 24, 27, 30, 31]. Perioperative complications occur infrequently, with the rate of symptomatic thromboembolic events reported at between 0.53 and 4.0% [11, 15, 30], septic arthritis between 0.14 and 0.48% [17, 23, 31], urinary tract infection at 0.74% [27], and an inpatient mortality rate under 0.01–0.02% [11, 27].…”

Diabetes in Orthopaedic Sports Medicine Surgeries Standard Review

“…Acutely elevated blood glucose may directly promote thrombosis and microvascular injury and is associated with a blunted cell-mediated immunity response to pathogens via impaired leukocyte mobilization, chemotaxis, and phagocytosis. 2,28 In addition, DM is independently associated with impaired promotion of a proinflammatory state in response to pathogens, regardless of HbA1c levels. 28 In patients who underwent knee arthroscopy, Canciene et al 8 found that uncontrolled DM was associated with an increased risk of postoperative infection in a national database study similar to that of Basques et al 7 An analysis of the Multicenter Orthopaedic Outcomes Network (MOON) database for patients undergoing anterior cruciate ligament reconstruction (ACLR) including 2,198 patients with a 6-year follow-up demonstrated that DM was a notable risk factor for surgical site infection (OR = 18.8).…”

“…2,28 In addition, DM is independently associated with impaired promotion of a proinflammatory state in response to pathogens, regardless of HbA1c levels. 28 In patients who underwent knee arthroscopy, Canciene et al 8 found that uncontrolled DM was associated with an increased risk of postoperative infection in a national database study similar to that of Basques et al 7 An analysis of the Multicenter Orthopaedic Outcomes Network (MOON) database for patients undergoing anterior cruciate ligament reconstruction (ACLR) including 2,198 patients with a 6-year follow-up demonstrated that DM was a notable risk factor for surgical site infection (OR = 18.8). 9 A separate study analyzed a cohort of patients who underwent revision ACLR from both the MOON database and the Multicenter ACL Revision Study (MARS), with a 2-year follow up.…”