Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)

  • Christina Lekkas
  • Richard Clarnette
  • Stephen E. Graves
  • Sophia RainbirdEmail author
  • David Parker
  • Michelle Lorimer
  • Roger Paterson
  • Justin Roe
  • Hayden Morris
  • Julian A. Feller
  • Peter Annear
  • Ben Forster
  • David Hayes



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.


Knee 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.

Authors’ contribution

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Christina Lekkas
    • 1
  • Richard Clarnette
    • 2
  • Stephen E. Graves
    • 1
  • Sophia Rainbird
    • 1
    Email author
  • David Parker
    • 3
  • Michelle Lorimer
    • 4
  • Roger Paterson
    • 5
  • Justin Roe
    • 6
  • Hayden Morris
    • 7
  • Julian A. Feller
    • 8
  • Peter Annear
    • 9
  • Ben Forster
    • 10
  • David Hayes
    • 11
  1. 1.Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)AdelaideAustralia
  2. 2.Wakefield Orthopaedic ClinicAdelaideAustralia
  3. 3.Northshore Private HospitalSt LeonardsAustralia
  4. 4.South Australian Health and Medical Research Institute (SAHMRI)AdelaideAustralia
  5. 5.Sportsmed SAStepneyAustralia
  6. 6.Mater HospitalWollstonecraftAustralia
  7. 7.St Vincent’s Private East Melbourne (Mercy)FitzroyAustralia
  8. 8.Epworth HealthCareRichmondAustralia
  9. 9.Bethesda HospitalClaremontAustralia
  10. 10.The Wesley HospitalAuchenflowerAustralia
  11. 11.Brisbane Private HospitalBrisbaneAustralia

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