A review of the outcome, safety, practicality and cost effectiveness of day surgery anterior cruciate ligament (ACL) reconstruction was studied in the British set-up. From January 2003 to May 2005, 75 patients who underwent day case arthroscopic ACL reconstruction without the use of tourniquet or nerve blocks, but using a pump-regulated saline-epinephrine irrigation system were studied prospectively. 68 patients had a hamstring tendon graft and 7 patients had patellar tendon graft reconstruction. None of the patients required overnight stay. Mean immediate postoperative Visual Analogue Score (VAS) for pain was 2.5 (range1–8) and 0.5 (range 0–3) at 6 weeks indicating excellent pain control. The mean follow-up was 14 months (range 6–30 months). We had no early or late complications in this series. ACL specific Mohtadi Quality of Life Index improved from pre-operative score of 20 (15–40) to 93 (80–100) at 9 months after surgery. The mean Modified Lysholm Knee Score was 93.9 points, (range 80–100) at the 9 months follow-up examination. On Tegner activity score, 68 patients returned to the same level of sporting activity at 8 months and the rest 7 patients dropped 1 level. The average saving per patient was in the range of 50–60% when compared to inpatient ACL reconstruction. In conclusion, day case ACL reconstruction using a pump-regulated saline-epinephrine irrigation system is safe, cost-effective and is the patient’s choice.
The aim was to demonstrate that day case Anterior Cruciate Ligament (ACL) reconstruction, without the use of a tourniquet, is clinically effective, cost effective, safe and “patient choice” procedure. Fifty patients who underwent day case, arthroscopic, ACL reconstruction without the use of a tourniquet, but using saline and epinephrine, pump regulated, irrigation. The same surgeon performed each case for the period May 2003 to April 2005. Seven patients had their tendons reconstructed with the use of patellar tendon grafts, the remainder, 43 patients, had hamstring tendon grafts. The study included 6 women and 44 men. This prospective study assessed cost effectiveness, clinical efficacy by measuring post-operative pain and postoperative results and finally whether this procedure remained the “patient choice”. The mean age was 30.6 years, (range 16 – 46). In addition to assessing level of immediate post operative pain the patients were also assessed at two weeks and six weeks for pain, range of movement, swelling and for the occurrence of any early post-operative complications. We were able to show that there was a significant cost benefit, approximately one third to a half in comparison to other local surgeons; that the study was clinically effective and that there were no reported early complications; and that all 50 patients would choose to have the surgery again as a day case procedure with this technique. We would like to present day case ACL reconstruction without the use of a tourniquet, as a safe option for the carefully selected patient.
This is a report of 30 patients who underwent arthroscopic, Anterior Cruciate Ligament (ACL) reconstruction without the use of a tourniquet, but using saline and epinephrine, pump regulated, irrigation. Each case was performed as a day case by the same surgeon for the period May 2003 to December 2004. 5 patients had their tendons reconstructed with the use of patellar tendon grafts, the remainder, 25 patients, had hamstring tendon grafts. The study included 4 women and 26 men. This prospective study assessed cost effectiveness, clinical efficacy by measuring post-operative pain and post-operative results and finally whether this procedure remained the “patient choice”. The mean age was 30.6 years, (range 17 – 46). In addition to assessing level of immediate post operative pain the patients were also assessed at two weeks and six weeks for pain, range of movement, swelling and for the occurrence of any early post-operative complications. We were able to show that there was a significant cost benefit, approximately one third to a half in comparison to other local surgeons; that the study was clinically effective and that there were no reported early complications; and that all 30 patients would choose to have the surgery again as a day case procedure with this technique. We would like to present day case ACL reconstruction as a safe option for the carefully selected patient and as a procedure that could perhaps be included in the orthopaedic basket for day case surgery in the UK.
