Increased operative time is an independent risk factor for surgical complications following isolated anterior cruciate ligament reconstruction in skeletally immature patients.

PURPOSE: In the context of increasing intensive year-round training amongst youth athletes, the incidence of paediatric anterior cruciate ligament (ACL) reconstruction has risen markedly. There is a growing interest in minimising surgical complications for these patients. Although the literature has demonstrated an association between operative time and complications for ACL reconstruction in adults, this has not been explored in younger patients. The primary purpose of this study was to determine whether operative time is a risk factor for complications following ACL reconstruction in skeletally immature patients. Secondary aims included identifying the most common types of complications in this cohort and identifying which of these complications were associated with increased operative time.

METHODS

A prospective, multicenter surgeon-driven registry was reviewed to identify skeletally immature patients who underwent primary isolated ACL reconstruction, with a minimum 8-month follow-up. Demographics, surgical characteristics, operative time and complications were recorded. Continuous variables were compared via an independent t-test or analysis of variance, and categorical variables were compared via Chi-squared or Fisher's exact tests. Comparisons were deemed to be statistically significant using a threshold of p < 0.05. Multiple logistic regression analysis was performed to control for baseline characteristics.

RESULTS

A total of 719 patients were included with a mean follow-up of 17.6 ± 8.6 months (range 8-30 months), 483 (67.2%) were male. Mean age was 13.3 ± 1.9 years. Mean operative time was 115.1 ± 44.2 min. The complication rate for the cohort was 15.3%. After adjusting for baseline characteristics, increased operative time remained an independent risk factor for developing a complication (OR = 1.19, p = 0.002). Specifically, increased operative time was an independent risk factor for surgical site infection (OR = 1.30, p = 0.019) and arthrofibrosis (OR = 1.36, p = 0.009).

CONCLUSIONS

Increased operative time was found to be an independent risk factor for complications following ACL reconstruction for skeletally immature patients. Specifically, operative time was associated with surgical site infection and arthrofibrosis. Future efforts to improve operative efficiency are warranted to improve patient outcomes.

LEVEL OF EVIDENCE: Level III.