Issue: Issue 5 2006
September 01, 2006
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Scandinavian ACL registries could serve as models for large European database

An extensive Web-based information source would improve ACL surgery and follow-up.

Issue: Issue 5 2006
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INNSBRUCK, Austria — Three Scandinavian databases may change ACL surgery throughout Europe if they are used as templates for a larger, Web-based resource, according to three sports medicine specialists from the region.

Nevertheless, orthopaedic surgeons overseeing the databases must overcome a few hurdles before a larger continent-wide database can be launched, said Magnus Forssblad, MD, PhD, of the Capio Artro Clinic, Stockholm; Lars-Petter Granan, of the Oslo Sports Trauma Research Center; and Martin Lind, MD, of the Sports Trauma Clinic, Aarhus University Hospital, Aarhus, Denmark, at the 12th ESSKA Congress, here.

The Scandinavian ACL registries – including those from Denmark, Norway and Sweden — have common variables. Still, they are kept separate to ensure their security and integrity, and the databases are designed to monitor quality control, identify poorly performing procedures and implants, and help standardize ACL reconstruction surgery, Forssblad said.

Clinical/subjective scores

The Swedish ACL registry began in January 2005 and includes data on etiology, previous injuries, associated injuries, graft and fixation methods, meniscus and cartilage surgery, surgery duration, antibiotic use and anticoagulants. Forssblad said the Swedish model uses the same data model used in Norway and Denmark with slight modifications, and officials in Perugia, Italy, launched a similar project this year.

“We can find out what we are doing, how we do it, why we do it and the best way to do it.”
— Magnus Forssblad, MD, PhD

The Swedish registry includes results from the Knee Osteoarthritis Outcome Score (KOOS) and EuroQual-5 questionnaire, a standardized instrument for recording subjective health outcomes. Postop evaluation data include KOOS and EQ-5 scores at one-, two-, five- and 10-year follow-up. Objective postop data include the KT-1000, Manual Lachman and one-hop test. The endpoint is total knee replacement.

The Norwegian ACL registry is the world’s first knee ligament registry, established in June 2004, Granan said. “Hard” endpoints include revision surgery, total knee replacement and death. The “soft” endpoint is a KOOS score of 5.

The Danish registry, launched in July 2005, is modeled on — and partly coordinated with — the Norwegian registry, Lind said. It includes objective International Knee Documentation Committee (IKDC) scores, injury and surgical data. Subjective measurements include KOOS and Tegner scores before surgery and at one-, five- and 10-year follow-ups.

Like its two counterparts, the Danish registry includes data on graft choice, implants, revisions, and meniscus/cartilage treatment, Lind said.

All three registries show that a majority of Scandinavian surgeons perform fewer than 10 ACL reconstructions annually, Forssblad added.

Web-based ESSKA database

Forssblad called for ESSKA to launch its own Web-based ACL registry modeled on the Scandinavian registries. Forssblad hopes such a system would allow European clinics to record and organize surgical data, preoperative and postoperative questionnaires (KOOS, EQ-5, SF-36, etc.), and objective scores (KT-1000, Lachman).

But before that can occur, officials must draft patient questionnaires, choose and build a database and Web server, scan and distribute forms to non-Internet users, compile statistics, integrate with other systems, and outline costs, he said.

Forssblad said an ACL database overseen by ESSKA could have a resounding impact on patient care in Europe and perhaps elsewhere.

“How will the Scandinavian ACL registry change ACL [treatment] in the future?” Forssblad said. “We can find out what we are doing, how we do it, why we do it and the best way to do it.”

Forssblad said an ACL registry is “essential” for developing surgical techniques. Furthermore, European cooperation would “increase quality, open barriers and create an open-minded international discussion about methods and results.”

At presstime, ESSKA could not be reached for comment.

For more information:
  • Forssblad M, Granan LP, Lind M. The Scandinavian ACL registry: why it will change ACL surgery in the future. Mini-symposium. Presented at the 12th ESSKA Congress and 5th World Congress on Sports Trauma. May 24-27, 2006. Innsbruck, Austria.