Abstract
Introduction
The purpose of this study was to compare satisfaction, clinical scores, and complications of patients operated on anterior cruciate ligament reconstruction (ACLR) in outpatient setting compared to patients operated in the conventional hospitalization.
Patients and methods
This prospective non-randomized study compared 30 patients (mean age 31 ± 9 years) operated on outpatient setting for an isolated ACLR matched 1:1 according to age, gender, body mass index, delay to surgery, and preoperative clinical score (IKDC) to 30 patients operated for an ACLR in our conventional hospitalization department during the same period. All the patients were operated on by the same surgeon. The same technique of anterior cruciate ligament reconstruction with using four bundles semitendinosus and cage fixation was used. The same anaesthesiologic protocol and perioperative cares were used in all patients. Patients’ satisfaction was assed using five questions about the course of surgery and hospitalization and a four-level satisfaction questionnaire (excellent, good, fair, and poor). Clinical scores (IKDC and KOOS) were compared preoperatively and at 1 year. Readmission within 30 day and complications at 1 year were compared in both groups.
Results
Satisfaction was significantly better in the group of day-case surgery and more patients of the group day-case surgery recommended this modality of treatment (29 against 24; p = 0.04). The IKDC score improved in the two groups (day-case group from 64 ± 17 to 86 ± 7; p < 0.001; conventional hospitalization from 60 ± 21 to 85 ± 10; p < 0.001), but no significant difference between two groups was found at 1 year (p = 0.86). No readmission was necessary in the two groups, but two revisions were needed in the group of the conventional hospitalization.
Conclusions
Results of our study showed that patients operated on day-case surgery for an isolated ACLR presented a higher rate of satisfaction compared to patients operated in the conventional hospitalization with comparable clinical results at 1 year.
Level of evidence
Level III, comparative study.
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References
Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91(10):2321–2328. doi:10.2106/JBJS.H.00539
Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr, Paletta GA Jr (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42(10):2363–2370. doi:10.1177/0363546514542796 Epub 2014 Aug 1
Lefevre N, Bohu Y, de Pamphilis O, Klouche S, Devaux C, Herman S (2014) Outpatient surgery feasibility in anterior cruciate ligament reconstruction: a prospective comparative assessment. Orthop Traumatol Surg Res 100(5):521–526. doi:10.1016/j.otsr.2014.03.024
http://www.has-sante.fr/portail/jcms/c_680973/prise-en-charge-therapeutique-des-lesions-meniscales-et-des-lesions-isolees-du-ligament-croise-anterieur-du-genou-chez-ladulte. Accessed 27 Jan 2015
http://www.atih.sante.fr/. Accessed 27 Jan 2015
Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93(11):994–1000
Kroneman MW, Westert GP, Groenewegen PP, Delnoij DMJ (2001) International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery. Ambul Surg 9:147–154
Khan T, Jackson WF, Beard DJ, Marfin A, Ahmad M, Spacie R, Jones R, Howes S, Barker K, Price AJ (2012) The use of standard operating procedures in day case anterior cruciate ligament reconstruction. Knee 19(4):464–468
Krywulak SA, Mohtadi NG, Russell ML, Sasyniuk TM (2005) Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: a randomized clinical trial. Can J Surg 48(3):201–206
Curran AR, Park AE, Bach BR Jr, Bush-Joseph CA, Cole BJ, Yao ES (2001) Outpatient anterior cruciate ligament reconstruction: an analysis of charges and perioperative complications. Am J Knee Surg 14(3):145–151
Edkin BS, Spindler KP, Flanagan JF (1995) Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy 11(4):404–409
Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, Roberts MS, Chelly JE, Harner CD, Fu FH (2004) Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology 100(3):697–706
Williams BA, Kentor ML, Vogt MT, Williams JP, Chelly JE, Valalik S, Harner CD, Fu FH (2003) Femoral-sciatic nerve blocks for complex outpatient knee surgery are associated with less postoperative pain before same-day discharge: a review of 1200 consecutive cases from the period 1996–1999. Anesthesiology 98(5):1206–1213
Calas P, Dorval N, Bloch A, Argenson JN, Parratte S (2012) A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation). Arthrosc Tech 1(1):e47–e52
Higgins LD, Taylor MK, Park D et al (2007) Fiabilité et validité du questionnaire d’évaluation subjective du genou de l’IKDC (Comité international de documentation du genou). Rev Rhum 74:1264–1269
Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson JN, Roos EM, Guillemin F, Maillefert JF (2008) Cross-cultural adaptation and validation of the French version of the Knee injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients. Osteoarthritis Cartilage 16:423–428
Kyung HS, Lee HJ, Oh CW, Hong HP (2014) Comparison of results after anterior cruciate ligament reconstruction using a four-strand single semitendinosus or a semitendinosus and gracilis tendon. Knee Surg Sports Traumatol Arthrosc. 2014 May 20 (Epub ahead of print)
Acknowledgments
We would like to thank Mister Mathieu Thomas for his help to write the anaesthetic protocol.
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Investigation performed at Aix-Marseille University, Marseille, France.
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Lunebourg, A., Ollivier, M., Delahaye, D. et al. Better satisfaction of patients operated on anterior cruciate ligament reconstruction in outpatient setting. A prospective comparative monocentric study of 60 cases. Arch Orthop Trauma Surg 136, 1709–1715 (2016). https://doi.org/10.1007/s00402-016-2552-3
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DOI: https://doi.org/10.1007/s00402-016-2552-3