Anterior cruciate ligament (ACL) tears are common injuries encountered by the orthopaedic surgeon, with ACL reconstruction (ACLR) considered the gold-standard treatment for active patients to restore knee stability and improve functional outcomes. At over 10-year follow-up, ACLR reduces the rate of subsequent meniscal injuries, reduces the rate of further surgery, and improves activity levels compared with nonoperative treatment. The incidence of ACLR is on the rise in the United States, increasing from 87,000 in 1994 to 130,000 in 2006. ACL deficiency is thought to lead to knee instability, resulting in secondary meniscal and cartilage damage and potentially to accelerated degenerative changes. Both patient and surgical factors are thought to influence ACLR functional outcomes and the rate of subsequent surgery, including the use of allografts, lateral meniscus status, body mass index (BMI), younger age, and smoking.
ACLR is generally considered to be a safe procedure and is performed predominantly on an outpatient basis in the United States. Although the literature addresses graft failure, there is relatively little information available defining the rate of ACLR complications in the early perioperative period, such as deep venous thrombosis (DVT), pulmonary embolism (PE), infections, hospital readmission, reoperation, and mortality. Studies of ACLR perioperative complications have predominantly been small single-center series addressing DVT and infections, with limited information on patient risk factors and less frequent complications such as PE. Only a few larger database studies of perioperative complications after ACLR have been reported in New York State and several European countries.
Knowledge of ACLR perioperative complication rates is important to allow surgeons to provide an accurate preoperative depiction of the risks and benefits of the procedure and potentially to identify patient and surgical risk factors that could be modified to prevent perioperative complications. The aim of this study was to determine the incidence of 30-day complications after ACLR and to identify patient and surgical risk factors for complications after ACLR using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The NSQIP database has recently been applied to study complications in a variety of orthopaedic procedures, but none has analyzed ACLR complications.