Abstract
We examined the relationship between waiting times for ACL surgery and the need for meniscal surgery at time of reconstruction. Using the Provincial Billing Database we identified 3812 ACL reconstructions between 1999–2001. Patients waited on average four hundred and twenty-two days from initial medical visit to reconstruction. 1722 patients (45%) required meniscal surgery with the ACL procedure. The delay to surgery was: two hundred and fifty-one days (no meniscal surgery required), four hundred and thirteen days (meniscal repair) and six hundred and seventy-six days (meniscectomies). This difference was significant, p< .01, ANOVA. The rate of meniscal surgery per time period was also significantly different: 17% if < 3months, 57% if > 6months. Our present Health Care policies place patients at risk of requiring avoidable meniscal surgery and developing osteoarthritis.
The purpose of this study was to examine the relationship between waiting times for ACL surgery and outcome.
The outcome measure was the need for meniscal surgery at the time of ACL reconstruction. The Provincial Data Base Billing information was reviewed for ACL reconstruction between 1999–2001. The simultaneous need for a meniscal procedure was noted. Tracking back in time, all demographic, diagnostic and interventional billing data (ICD & Visit billing code) preceding their ACL surgery was recorded.
Between 1999–2001, 3812 ACL reconstructions were identified. Of these, 1722 patients required a meniscal procedure (45%). On average, patients waited over four hundred and twenty-two days from injury to reconstruction. Patients who did not require any meniscal procedure waited on average two hundred and fifty-one days, meniscal repairs waited four hundred and thirteen days, while meniscectomies waited six hundred and seventy-six days. More importantly, the need for a meniscal procedure correlated with the timing of surgery: 17% of those reconstructed < three months from injury had a significant meniscal injury, compared to 57% at > six months. Almost half of which (48%) required a meniscectomy for significant meniscal injury. These differences all attained statistical significance (p< 0.01).
Previous reports suggest that the ACL-deficient knee increases the risk of meniscal injury and meniscal incompetence hastens OA. Our data show a progressive increase in the rate to meniscal surgery, and meniscal injury complexity with time. These delays and rates are higher than the ones proposed in the literature.
It appears that the experience in our Province simply reproduces (rather than improves upon) the natural history of the ACL injury. We postulate restricting access to specialists and to surgery place the patient at risk for requiring avoidable surgery and developing osteoarthritis
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
