Abstract
Aims
Wales in collaboration with the Welsh Assembly Government, has attempted to start a national ligament register.
Introduction
Norway is the lead in Europe for running a successful national quality knee ligament registry. As yet there is no UK wide registry encompassing all forms of knee ligament surgery. The issue has been discussed at previous society meetings, but no consensus has been reached.
Method
A pilot study covering three NHS Trusts in South Wales was run between April 2010 and September 2010. Data is gathered prospectively on non-operatively treated and surgically treated knee ligament injuries performed in the regions. This data is recorded on the WKLR form which is then sent to the WKLR centre and entered onto a secure database.
Four knee surgeons agreed to take part in the study, from three NHS Health Boards. The data is recorded at the time of the operation on a tick box form akin to that used by the NJR. The prospectively gathered data is stored at the central registry office in Princess of Wales Hospital Bridgend.
Results
A total of 68 forms were returned to the registry, 58 Males and 10 Females, average age 30 and 35 years respectively. Four per cent of ACL ruptures were treated non-operatively. Sixty two (96%) ACL ruptures were reconstructed; 57 primary reconstructions; 3 revisions; 2 were multi-ligament injuries. The most common mechanisms of injury in females were basketball and football. Rugby was the most common mechanism for males. Six PCL injuries were reported, half (3) were reconstructed, all using allograft Achilles tendon.
Of the fifty seven primary ACL reconstructions, twenty nine (47%) ACL reconstructions were recorded with no meniscal injury, thirty (53%) of ACL reconstructions had concomitant meniscal injury, which equates to 8% requiring repair (5 medial, 1 lateral) and 25 (43%) requiring meniscectomy for non-repairable tears (15 medial, 10 Lateral).
Cartilage lesions were seen in 18 reconstructions (27%). Of these 2 (3%) had synthetic mosaic plasty. Four lesions (6%) had chondroplasty and the remaining 12 (18%) treatment was not required but noted.
Conclusion
The WKLR, although in its infancy, has shown that a ‘National Quality Database’ of this type is feasible and will provide the necessary quality assurance demanded by this active young group of patients.
The WKLR will provide an invaluable research tool for assessing and comparing outcomes of the various techniques, graft types, and fixation devices. Failing implants can be identified early. Under performing institutions can be identified, and performance can be compared to the national average. All of these aims are focused at improving patient safety, satisfaction and outcome.
