ACL registry linked with reduced use of high-risk grafts
SAN DIEGO — Use of information from an ACL registry positively influenced patient care by providing feedback to surgeons and decreased use of procedures or implants shown to produce poor results, according to study results presented here.
“Within our registry, we found a decrease in the overall allograft use — a 38% decrease in the use of high-risk allografts [and] a 68% decrease of allografts in young patients,” Gregory B. Maletis, MD, said at the American Orthopaedic Society for Sports Medicine Annual Meeting.
According to Maletis, previous research has shown an increased risk of revision in ACL reconstruction (ACLR) with allografts compared to use of bone-patellar tendon-bone autografts, especially in patients younger than 21 years. The current study examined the effect the Kaiser ACL Registry on high-risk allograft use in high-risk patients undergoing ACLR from 2008 to 2015. The Kaiser ACL Registry includes data on 346 surgeons, more than 35,000 patients and about 40,000 cases. Surgical outcomes included revisions, reoperations, inflections and VTE.
Registry members received a report on their outcomes of surgery as well as ACLR results from other hospitals on a regional and a national level through newsletters, peer-reviewed publications, and internal and external conferences. Surgeons who were the chief of orthopedics in their hospital were given the goal of decreasing high-risk graft use in high-risk patients and monitored results quarterly.
Within the registry, 45% of ACLRs used allografts in 2010, with allograft use peaking in patients younger than 21 years at 28% in 2009. By 2015, 33% of ACLRs used allografts — a 27% decrease. In patients younger than 21 years, use of allografts dropped to 9% in 2015. This was a 68% decrease. Overall, researchers found use of high-risk grafts decreased by 38%.
“It takes, on average, 17 years for research evidence to reach clinical practice and only 14% of original research is actually implemented,” Maletis said. “The value of a registry is that it can provide a real-world look at clinical practice. It can detect procedures and devices that result in premature failure, identify prognostic factors that lead to good and poor outcomes, and improve treatment outcomes through feedback to surgeons.” – by Laura Kincaid
Maletis, GB, et al. Paper 148. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 5-8, 2018; San Diego.
Disclosure: Maletis reports no relevant financial disclosures.