Characteristics of early complications in isolated primary anterior cruciate ligament reconstruction surgery.

PURPOSE: The early complications of isolated anterior cruciate ligament reconstruction surgery (ACLR) have not been well characterized using large databases. This study aims to characterize incidence, impact, and risk factors for short-term operative complications following elective, isolated ACLR surgery. We hypothesize that demographic and perioperative factors may predict 30-day complications after isolated ACLR. METHODS: This case-control analysis of the American College of Surgeons National Surgical Quality Improvement Program Database (2005-2017) used Current Procedural Terminology codes to identify elective, isolated ACLR patients. Patients undergoing concomitant procedures were excluded. Complications were analyzed using bivariate analysis against demographic variables. Multiple stepwise logistic regression was used to identify independent risk factors for morbidity after ACLR. RESULTS: A total 12,790 patients (37.0% female, p = 0.674) were included with a mean age of 32.2 years old (SD 10.7 years, p < 0.001). Mean BMI was 27.8 kg/m2 (6.5) where 28.9% of patients had a BMI > 30 (p = 0.064). The most common complications were wound-related (0.57%). In cases with complications, there were higher rates of (1.3% vs 0.8%, p = 0.004) prolonged operation (> 1.5 h), higher rate (2.9% vs 1.8%, p = 0.004) of extended length of stay (≥ 1 day), unplanned reoperation (15.8% vs 0.3%, p < 0.001), and unplanned readmission (17.5% vs 0.3%, p < 0.001). Multivariate analysis showed prolonged operative time (p = 0.001), dyspnea (p = 0.008), and non-ambulatory surgery (p = 0.034) to be predictive of any complication. Dependent functional status (p = 0.091), mFI-5 > 0.2 (= 0.173), female sex (p = 0.191), obesity (p = 0.101), and smoking (p = 0.113) were not risk factors for complications. CONCLUSION: ACLR is associated with low rates of morbidity and readmissions. The most common comorbidities, complications, and predictors of morbidities were identified to aid surgeons in further reducing adverse outcomes of ACLR. Operative time > 1.5 h, dyspnea, and non-ambulatory surgery are predictive of complications.

Perioperative outcomes in isolated versus multiligamentous anterior cruciate ligament reconstruction: a retrospective cohort analysis.

PURPOSE: The outcomes of anterior cruciate ligament reconstruction in the setting of multiligamentous knee injury (M-ACLR) have not been well characterized compared to isolated ACLR (I-ACLR). This study aims to characterize and compare short-term outcomes between I-ACLR and M-ACLR. METHODS: This is a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017. Current Procedural Terminology codes were used to identify and compare elective I- and M-ACLR patients, excluding patients undergoing concomitant meniscal or chondral procedures. Patient demographics and outcomes after I- and M-ACLR were compared using bivariate analysis. Multiple logistic regression analyzed if multiligamentous ACLR was an independent risk factor for adverse outcomes. RESULTS: There was a total of 13,131 ACLR cases, of which 341 were multiligamentous cases. The modified fragility index-5 was higher in multiligamentous ACLR (p < 0.001). Multiligamentous ACLR had worse perioperative outcomes, with higher rate of all complications (3.8%, p = 0.013), operative time > 1.5 h (p < 0.001), length of stay (LOS) ≥ 1 day (p < 0.001), wound complication (2.1%, p = 0.001), and intra- or post-op transfusions (p < 0.001). In multiple logistic regression, multiligamentous ACLR was an independent risk factor for LOS ≥ 1 (odds ratio [OR] 5.8), and intra-/post-op transfusion (OR 215.1) and wound complications (OR 2.4). M-ACLR was not an independent risk factor for any complication, reoperation at 30 days, readmission, urinary tract infection (UTI), or venous thromboembolism (VTE). CONCLUSION: M-ACLR generally had worse outcomes than I-ACLR, including longer LOS, need for perioperative transfusions, and wound complications.

Is the Actual Failure Rate of Hip Arthroscopy Higher Than Most Published Series? An Analysis of a Private Insurance Database.

Background: The use of hip arthroscopy (HA) for the management of intra-articular hip pathology has increased greatly, with a 600% increase in utilization from 2006-2010. Studies have demonstrated good to excellent outcomes in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) syndrome. However, some patients undergoing primary hip arthroscopy will require revision hip arthroscopy (revision HA) or conversion to total hip arthroplasty (THA). The purpose of the present study was to evaluate the association between hip arthroscopy failure and (1) osteoarthritis, (2) age > 40 years, and (3) psychiatric comorbidities. Methods: The Humana Inc. insurance claims database was used to identify patients undergoing hip arthroscopy between 2007 and 2015, with query by CPT (current procedural terminology code) of more than 25 million deidentified insurance and Medicare beneficiary claims. Following primary hip arthroscopy, patients were longitudinally tracked for subsequent ipsilateral hip arthroscopy (revision HA) or total hip arthroplasty (THA) with a minimum of 1-year clinical follow-up from the primary HA procedure. Hip arthroscopy failure (HA failure) was defined specifically as patients who underwent a revision HA or THA with a minimum of 1-year of clinical follow-up from the primary HA procedure. Variables assessed included presence of pre-existing osteoarthritis, age < 40 years or age > 40 years, and presence of preoperatively diagnosed psychiatric comorbidities including depression or anxiety. The relationships between revision HA, THA, or HA failure and these variables were assessed utilizing univariate and multiple logistic regression analysis. Independent predictors of revision ipsilateral hip arthroscopy and subsequent hip arthroplasty were identified using multiple logistic regression. Results: In total, 785 patients (64.1% female) underwent primary hip arthroscopy. The overall failure rate with a minimum of 1-year clinical follow-up from the index HA procedure was 18%[140/785; 8% (63/785) revision hip arthroscopy, 10% (82/785) THA]. Multivariable logistic regression analysis identified psychiatric comorbidities (Odds Ratio [OR] 2.8, 95% Confidence Interval [CI] 1.2-6.2, p<0.01) as the only independent predictor of hip arthroscopy failure (revision HA or THA). Independent predictors of revision HA included both psychiatric comorbidity (OR 2.8, 95% CI 1.2-6.2, p<0.01) and age < 40 years (OR 2.6, 95% CI 1.4-5.0, p<0.01), while age > 40 years (OR 3.09, 1.47-7.25, p<0.005), smoking (OR 2.05, 95% CI, 1.68-1.88, p=0.02), and osteoarthritis (OR 3.24, 95% CI 1.98-5.43, p<0.001) predicted conversion to THA. Conclusion: The hip arthroscopy failure rate of 18% in the present study is alarmingly high, a figure much higher than reported in previously published series. Patient factors associated with conversion to THA included age > 40 years, smoking, and preexisting osteoarthritis. The presence of psychiatric comorbidities, specifically depression and anxiety, was independently associated with revision HA and overall HA failure.Level of Evidence: III.

Intercarpal ligamentous laxity in cadaveric wrists.

The purposes of this study were to define the range of laxity of the interosseous ligaments in cadaveric wrists and to determine whether this correlated with age, the morphology of the lunate, the scapholunate (SL) gap or the SL angle. We evaluated 83 fresh-frozen cadaveric wrists and recorded the SL gap and SL angle. Standard arthroscopy of the wrist was then performed and the grades of laxity of the scapholunate interosseous ligament (SLIL) and the lunotriquetral interosseous ligament (LTIL) and the morphology of the lunate were recorded. Arthroscopic evaluation of the SLIL revealed four (5%) grade I specimens, 28 (34%) grade II, 40 (48%) grade III and 11 (13%) grade IV. Evaluation of the LTIL showed 17 (20%) grade I specimens, 40 (48%) grade II, 28 (30%) grade III and one (1%) grade IV. On both bivariate and multivariate analysis, the grade of both the SLIL and LTIL increased with age, but decreased with female gender. The grades of SLIL or LTIL did not correlate with the morphology of the lunate, the SL gap or the SL angle. The physiological range of laxity at the SL and lunotriquetral joints is wider than originally described. The intercarpal ligaments demonstrate an age-related progression of laxity of the SL and lunotriquetral joints. There is no correlation between the grades of laxity of the SLIL or LTIL and the morphology of the lunate, the SL gap or the SL grade. Based on our results, we believe that the Geissler classification has a role in describing intercarpal laxity, but if used alone it cannot adequately diagnose pathological instability. We suggest a modified classification with a mechanism that may distinguish physiological laxity from pathological instability.