Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)
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Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible.
Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data.
A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study.
It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent would not be an issue in for a national registry where inclusion is automatic unless the patient wishes to opt out. The collection of post-operative patient-reported outcome measures (PROMs) is more problematic, due to an insufficient proportion of individuals providing patient-reported outcomes. Alternative outcome measures are required for an ACL registry in Australia to be successfully implemented.
Level of evidence
Diagnostic, Level III.
KeywordsKnee reconstruction Knee ligaments ACL General sports trauma Clinical assessment/grading scales Anterior cruciate ligament
The authors thank the AOA, AOANJRR and the hospitals, orthopaedic surgeons, and patients whose data made this work possible. The authors gratefully acknowledge all surgeons and hospital coordinators of the participating sites for their cooperation in completing the operation forms sent to the AOANJRR and the assistance from all office staff involved from surgeon private rooms during the recruitment period.
All authors actively worked on the development of the manuscript. SG, RC and DP designed the study. RP, HM, JF, PA, DH, BF, JR and RC recruited the participants and collected data. CL coordinated the study: liaised with the hospitals and clinicians, gained ethics approval and conducted the patient notifications. ML analysed the data and prepared the tables and figures. CL, SG, RC and CL prepared an initial draft of the manuscript. SR and SG prepared the final draft, and all authors edited the manuscript, and read and approved the final version of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
Funding for the pilot study was provided by the AOANJRR through its contract between the AOA and the Commonwealth of Australia's Department of Health and Ageing.
The study was approved by the Commonwealth of Australia as a Declaration of Quality Assurance Activity under section 124X of the Health Insurance Act, 1973. All investigations were conducted in accordance with ethical principles of research (the Helsinki Declaration II).
Informed consent was obtained from all individual participants included in the study.
- 2.Australian Orthopaedic Association National Joint Replacement Registry (2014) Annual Report AOA, AdelaideGoogle Scholar
- 9.Janssen KW, Orchard JW, Driscoll TR, van Mechelen W (2012) High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: Time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports 22:495–501CrossRefPubMedGoogle Scholar
- 15.Paxton EW, Namba RS, Maletis GB, Khatod M, Yue EJ, Davies M, Low RB Jr, Wyatt RW, Inacio MC, Funahashi TT (2010) A prospective study of 80,000 total joint and 5000 anterior cruciate ligament reconstruction procedures in a community-based registry in the United States. Bone Jt J (Am) 92:117–132CrossRefGoogle Scholar
- 16.Persson A, Fjeldsgaard K, Gjertsen JE, Kjellsen AB, Engebretsen L, Hole RM, Fevang JM (2014) Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004–2012. Am J Sports Med 42:285–291CrossRefPubMedGoogle Scholar
- 17.Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M (2014) Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish registry of knee ligament reconstruction. Am J Sports Med 42:278–284CrossRefPubMedGoogle Scholar
- 18.Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC (2013) Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 29:98–105CrossRefPubMedGoogle Scholar
- 21.Swedish National ACL Register (2013) Annual Report 2013. The Swedish National Knee Ligament Register, StockholmGoogle Scholar