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 management of symptomatic single bundle Anterior Cruciate Ligament (ACL) ruptures is still a surgical dilemma. Preservation of the intact fibres of the ACL bundle is considered to be a possible source of reinnervation of the ACL autograft which reflects on better proprioceptive knee control after major ligament reconstruction. Results of a prospective study of 67 patients who had a double stranded but single bundle Anterior Cruciate Ligament (ACL) reconstruction for partial ACL ruptures are presented. There were 43 males and 24 females in this study with a mean age at the time of injury of twenty-five years (14 – 40). Eight played sport professionally and thirty-four played at a competitive level. A valgus twisting force was the most common mechanism of injury. Mean injury to operation time was 7.5 weeks (2–12). All procedures were done arthroscopically without using tourniquet, but using an arthroscopy pump and irrigation fluid containing adrenaline. The semitendinosis hamstring graft was used in all reconstructions. The mean follow-up period was 3.3 years (2–5.4). There was one major complication, who developed a reflex sympathetic dystrophy following a saphenous nerve neuroma. The Quality of Life (QOL) score was assessed using the Mohtadi index. The mean pre-operative QOL score of 30 (13–50) was improved to 93 (70–100) post-operatively. Fifty patients were able to return to their previous sporting level at a mean duration of 9 months (6–12).

Preservation of mechanoreceptors by performing a double stranded, single bundle ACL reconstruction in partial ACL ruptures in high demand patients yields good results and enables early return to high demand sports.