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The current rate of day case anterior cruciate
ligament reconstruction (ACLR) in France
remains low. Reasons for inpatient procedure
include pain control, prolonged recovery time,
and surgeon’s fear of compromise to safety and
reduction in patient satisfaction [1, 2]. The
feasability of outpatient surgery for ACL
reconstruction is well known, and many US
studies have shown favourable results for the
last twenty years, including low rates of
readmissions in the post-operative period and
similar pain control and satisfaction rates
between ambulatory and inpatient groups [3, 4].
Cost containment issues have had major impact
on the increasing number of daycase procedures
in orthopaedic departments over the world [6].
The SFA
(SociétéFrancophone d’Arthroscopie)
led a symposium in 2015 to define the specific
pathway for day case ACL reconstruction.
Between January 2014 and March 2015, ten
different french orthopaedic departments
included prospectively 1076 patients who
underwent primary arthroscopic ACL re
constructions with all surgical arthroscopic
techniques and autograft used in France
(hamstring, short graft with semi tendinosous
tendon, patellar tendon and fascia lata). Two
groups were compared: an outpatient group (OG)
including680patientswhounderwent ambulatory
surgery and a hospitalization group (HG)
including 396 patients who underwent inpatient
procedure, with a post-operative stay ranging
from1 to 4 days.The two groupswere comparable
at inclusion in terms of gender, age, sport activity,
IKDC score and Lysholm score. Three types of
anaesthesia were realised in both groups: general
anaesthesia (60%), spinal anaesthesia (33%) or
four regional nerve blocks anaesthesia (7%,
combined femoral, sciatic subgluteal, obturator
and lateral femoral cutaneous nerve blocks). Four
types of local anesthestic injections were also
performed in both groups, except for patients
who underwent procedure under only regional
blocks anesthesia: single injection blocks,
continuous femoral nerve blocks with catheter,
intraarticular local anesthesia injection and
hamstring donor-site block.
Themain evaluation criterionwas postoperative
pain on D0 to D5 assessed on a Visual Analog
Scale (VAS - 0 no pain to 10 maximum pain)
between the outpatient group and the
hospitalization group.
The secondary evaluation criteria were the
influences of surgical technique, anaesthesia
modality and type of analgesic procedures in
the pitfalls of ambulatory surgery, the
comparison of complications in both groups,
and the patient satisfaction on the admission
modality on D5.
MANAGEMENT OF DAY CASE
ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION
T. CUCURULO, E. SERVIEN
& la Société Francophone d’Arthroscopie