ANTERIOR CRUCIATE LIGAMENT INJURY – THE PATHWAY FROM INJURY TO SURGERY

Abstract

Background: 10 years ago Bollen reported that, in the UK, the diagnosis of ACL injury was made by the primary treating physician in only 9% of cases and that the mean delay from injury to diagnosis was 21 months.

Aim: To assess if accuracy and delay of diagnosis of ACL rupture, and delay to surgery, have improved with time and with the implementation of local measures to address these issues.

Methods: The records of 100 patients who had undergone ACL reconstruction by the senior author at a single NHS hospital, were reviewed to assess: date of injury, date of first presentation, initial physician’s diagnosis, delay from initial presentation to correct diagnosis and date of surgery.

Results: When an diagnosis was made by the primary treating physician, it was correct in 43% of cases. 19 patients had arthroscopies and 53 had MRI scans. Mean delay from injury to presentation was 3.2 months and from presentation to diagnosis was 4.3 months (influenced by NHS MRI waiting times). Mean time from diagnosis to surgery was 11.3 months (reflecting the NHS waiting list during the study period). Mean time from injury to surgery was 17.3 months (range 2.3 to 97 months).

Patients referred electively by their GP’s had longer delays to correct diagnosis and to surgery. Patients attending A& E and referred to an Acute Knee Injury clinic were diagnosed more accurately and had shorter waits for diagnosis and surgery.

Conclusion: Correct diagnosis rates and delays from injury to diagnosis have improved substantially (compared with Bollen 1996). Patient awareness needs to be improved to decrease the delay to presentation. Acute Knee Injury clinics improve speed and accuracy of diagnosis. Decreasing NHS waits for MRI scans and surgery should further decrease delays from diagnosis to surgery in future.