In the National Health Service although some units perform ACL reconstruction as a day case, others continue to admit patient’s overnight due to a possible medicolegal implication of complication including postoperative pain, nausea and vomiting and urinary retention. The aim of this study is to assess the safety, efficacy of post operative pain control, cost effectiveness of the day case procedure and the role of extended acute ‘hospitalcare in the community’ by a Rapid Response Team. We carried out a retrospective review of data of fifty-seven patients who underwent day case ACL reconstruction with pre-emptive analgesia and postoperative pain control with analgesics and non-steroidal anti-inflammatory drugs. Rapid Response Team consisting of qualified nurses who provide intensive level of nursing cares in-patients home provided the postoperative community care. Aim of this team is to reduce the pressure of acute hospital beds. Out of fifty-seven patients, adequate pain relief was achieved in 92.8%. One patient needed admission for pain relief, one patient needed admission for excessive bleeding and five patients had nausea and vomiting. Cost analysis showed that ACL reconstruction is cost effective. We conclude that ACL reconstruction is a safe procedure provided attention is given to patient selection, preadmission screening, patient education, preemptive analgesia with appropriate pain management and post operative community care.
Nomograms derived from mathematical analysis indicate that the level of malunion is the most important determinant of changes in the moment arm of the knee, the plane of the ankle and alterations in limb length. Testing in five patients undergoing reconstruction showed a mean error of postoperative limb length of 2.2 mm (
