2015 ISAKOS Biennial Congress ePoster #1309
Managment of Arthroscopic Anterior Cruciate Ligament Reconstruction (Hamstring) in Outpatient Surgery: Feasibility Based on a Continuous Series of 135 Patients
Christophe Trojani, MD, PhD, Nice FRANCE
Michel Carles, MD, Nice FRANCE
Pascal Boileau, MD, Prof., Nice FRANCE
L'Archet 2 Hospital, Nice, FRANCE
FDA Status Cleared
Summary: The results of the present study suggest that ACL reconstruction by hamstring graft no longer justifies a systematic conventional hospital admission
ePoster Not Provided
The management of ACL reconstruction by hamstring graft in ambulatory surgery is scarcely known for reasons related to postoperative surgical site monitoring or to pain management.
Observational study of patients in day surgery for ACL reconstruction (hamstring graft). The surgical procedure consisted of an arthroscopic knee ligamentoplasty with the treatment of possible meniscal lesions. The anesthetic management included a femoral block with analgesic catheter (ultrasound) and post op care with pump ± bolus. Postoperative analgesia consisted of the systematic administration of paracetamol, NSAIDs and nefopam, and tramadol / oral morphine as fallback. Return to home was done with a standard Zimmer splint without anticoagulation. Home monitoring was done by a home health-care nurse for 48 hours, upto the withdrawal of the femoral catheter. The data was collected and entered into the Orthoplus ™ software , and analyzed using the MedCalc software 11.0.
One hundred and thirty-five patients were included, age 31 ± 11 years, sex ratio 2.1. The BMI was 24 ± 4 kg / m², 93% of patients were ASA 1, 7% ASA2, 68% of patients were non-smokers, <21% 10PA ,> 11% 10PA. The operative time was 68 ± 18 minutes. The anesthetic management was general anesthesia in half of the cases and spinal anesthesia in the other. The femoral catheter was maintained by infusion of ropivacaine 2 mg / ml. The length of stay in the outpatient unit after surgery was 6.5 ± 1.6 hours [3.5 min-max 9]. Immediate hospitalization (if discharge not possible) was required for 13 patients (9.6%) due to pain n = 6, dizziness/PONV n = 6, and ambulation discomfort n = 1, with a discharge 1 day after surgery for 12 patients and 2 days after surgery for the last. Two patients required readmission 2 days after surgery due to a fall at home (n = 1) and phlebitis with no consequence (n = 1). Pain management was assessed on Day 1 and Day 2 by a digital scale (DS) (on a scale going from 0 = no pain to 10 = unbearable pain), respectively 2.8 ± 1.8 and 2.1 ± 2.2, with 2% of patients having a score > 6. Patient satifsfaction was 9.5 ± 1.8 [0-10] (digital scale going from 0 = very dissatisfied to 10 = very satisfied) and 94% of patients replied yes to the the question: would you like the same care in the case of a future surgery.
Outpatient surgery of ACL reconstruction by hamstring graft does not have a higher complication rate than other ambulatory procedures. The results of the present study suggest that ACL reconstruction by hamstring graft no longer justifies systematic conventional hospital admission.