Complications following anterior cruciate ligament reconstruction in the English NHS

Published:January 10, 2011DOI:


      Unlike the English National Joint Registry (NJR) for arthroplasty, no surgeon driven national database currently exists for ligament surgery in England. Therefore information on outcome and adverse events following anterior cruciate ligament (ACL) surgery is limited to case series. This restricts the ability to make formal recommendations upon surgical care. Prospectively collected data, which is routinely collected on every NHS patient admitted to hospital in England, was analysed to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, 30-day wound infection and readmission rates following primary ACL reconstruction between March 2008 and February 2010 (13,941 operations, annual incidence 13.5 per 100,000 English population). 90-day DVT and PTE rates were 0.30% (42) and 0.18% (25) respectively. There were no in-hospital deaths. 0.75% (104) of the consecutive patient cohort had a wound complication recorded. 0.25% (35) underwent a further procedure to wash out the infected knee joint and 1.36% (190) were readmitted to an orthopaedic ward within 30 days. This is the first national comprehensive study of the incidence of significant complications following ACL surgery in England. This should allow meaningful interpretation of future baseline data supporting the development of a national ligament registry.


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        • Lyman S.
        • Koulouvaris P.
        • Sherman S.
        • Do H.
        • Mandl L.A.
        • Marx R.G.
        Epidemiology of anterior cruciate ligament reconstruction.
        J Bone Joint Surg Am. 2009; 91: 2321-2328
        • National Institute for Health and Clinical Excellence
        CG92 Venous thromboembolism - reducing the risk: full guideline.
        (January 2010 (Section 5.9, p126 and Section 13, p269). Last accessed 27/10/2010)
        • Allum R.
        Aspects of current management. Complications of arthroscopic reconstruction of the anterior cruciate ligament.
        J Bone Joint Surg Br. 2003; 85B: 12-16
        • Kapoor B.
        • Clement D.J.
        • Kirkley A.
        • Maffulli N.
        Current practice in the management of anterior cruciate ligament injuries in the United Kingdom.
        Br J Sports Med. 2004; 38: 542-544
        • Janssen R.P.A.
        • Sala H.A.
        Fatal pulmonary embolism after anterior cruciate ligament reconstruction.
        Am J Sports Med. 2007; 35: 1000-1002
      1. Best practice for primary anterior cruciate ligament reconstruction. NHS Evidence- musculoskeletal.
        (Last accessed 04/11/2010)
      2. The Information Centre. HES online. Last assessed 01/11/2010.

      3. Jameson SS, Augustine A, James P, Townshend D, Reed MR. Major complications following foot and ankle surgery – analysis using national hospital episode statistics. J Bone Joint Surg Proceedings in press.

      4. Connecting for Health.
        (Last assessed 24/10/2010)
        • Connecting for Health
        Pseudonymisation implementation policy.
        (Last accessed 04/11/2010)
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • Mackenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chron Dis. 1987; 40: 373-383
      5. Copyright (c) 2010. Re-used with permission of the Health and Social Care Information Centre. All rights reserved.

        • Spiegelhalter D.J.
        Funnel plots for comparing institutional performance.
        Stat Med. 2005; 24: 1185-1202
        • Wilson E.B.
        Probable inference, the law of succession, and statistical inference.
        J Amer Statist Assoc. 1927; 22: 209-212
        • Bland J.M.
        • Altman D.G.
        The odds ratio.
        BMJ. 2000; 320: 1468
        • Muscolo D.L.
        • Carbo L.
        • Aponte-Tinao L.A.
        • Ayerza M.A.
        • Makino A.
        Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction.
        Clin Orthop Relat Res. 2009; 467: 2420-2425
        • Kmietowicz Z.
        Hospitals will be fined for emergency readmissions, says Lansley.
        BMJ. 2010; 340: c3079
        • Sweetland S.
        • Green J.
        • Liu B.
        • Berrington de González A.
        • Canonico M.
        • Reeves G.
        • et al.
        Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study.
        BMJ. 2009; 339: b4583-b4591
        • Jameson S.S.
        • Bottle A.
        • Malviya
        • Muller S.D.
        • Reed M.R.
        The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb.
        J Bone Joint Surg Br. 2010; 92: 123-129
        • National Joint Registry
        5th Annual Report.
        (Last accessed 23/10/2010)
        • Cullison T.R.
        • Muldoon M.P.
        • Gorman J.D.
        • Goff W.B.
        The incidence of deep vein thrombosis in anterior cruciate ligament reconstruction.
        Arthroscopy. 1996; 12: 657-659
        • Sherman O.H.
        • Fox J.M.
        • Snyder S.J.
        • Del Pizzo W.
        • Friedman M.J.
        • Ferkel R.D.
        • et al.
        Arthroscopy—“no problem surgery”.
        J Bone Joint Surg Am. 1986; 68: 256-265
        • Carlson E.
        • Steiner M.
        • Brown C.
        Thromboembolic disease following arthroscopic anterior cruciate ligament surgery.
        in: Presented at the annual meeting of the American Orthopaedic Society of Sports medicine, Sun Valley, ID. 1993 (July)
        • Patel N.
        • Chandratreya A.
        • Radcliffe G.
        • Bollen S.
        Current ACL practices in the UK: a postal survey of BASK members.
        J Bone Joint Surg Br. 2008; 90-B: 583
        • Deehan D.J.
        • Salmon L.J.
        • Webb V.J.
        • Davies A.
        • Pinczewski L.A.
        Endoscopic reconstruction of the anterior cruciate ligament with an ipsilateral patellar tendon autograft.
        J Bone Joint Surg Br. 2000; 82: 984-991
        • Pinczewski L.A.
        • Lyman J.
        • Salmon L.J.
        • Russell V.J.
        • Roe J.
        • Linklater J.
        A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial.
        Am J Sports Med. 2007; 35 (Epub 2007 Jan 29): 564-574
        • Webb J.M.
        • Corry I.S.
        • Clingeleffer A.J.
        • Pinczewski L.A.
        Endoscopic reconstruction for isolated anterior cruciate ligament rupture.
        J Bone Joint Surg Br. 1998; 80: 288-294
        • Edwards P.
        Questionnaires in clinical trials: guidelines for optimal design and administration.
        Trials. 2010; 11: 2
        • Granan L.P.
        • Bahr R.
        • Steindal K.
        • Furnes O.
        • Engebretsen L.
        Development of a national cruciate ligament surgery registry: The Norwegian National Knee Ligament Registry.
        Am J Sports Med. 2008; 36: 308-315
        • Granan L.P.
        • Forssblad M.
        • Lind M.
        • Engebretsen L.
        The Scandinavian ACL registries 2004–2007: baseline epidemiology.
        Acta Orthop. 2009; 80: 563-567
        • Lind M.
        • Menhert F.
        • Pedersen A.
        The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5, 818 knee ligament reconstructions.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 117-124
        • Westaby S.
        • Archer N.
        • Manning N.
        • Adwani S.
        • Grebenik C.
        • Ormerod O.
        • Pillai R.
        • Wilson N.
        Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality.
        BMJ. 2007; 335: 759