Document Title: Larson-AJSM-Jan04.shtml
Article Title: Bilateral Anterior Cruciate Ligament Reconstruction as a Single Procedure Evaluation of Cost and Early Functional Results
Authors: Christopher M. Larson MD, David A. Fischer MD, J. Patrick Smith MD and Joel L. Boyd MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: January 2004
Volume 32, pages 197-200
Keywords: bilateral ACL reconstruction, both knees simultaneously, rehabilitation, post-operative, physiotherapy, cost comparison, pecuniary resources disbursement.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This article shows that when someone presents with bilateral ACL tearing, having both ACLs reconstructed simultaneously engenderes benefits of time saved and less cost. From the patient's point of view, the real benefits might apply more to the insurance companies (who, of course, are forever interested in inbuing orthopedic surgeries with the efficiency of a high-speed office photocopier); however, patient benefits of simultaneous reconstruction could accrue in the form of less likelihood of developing limping (a consequence of many types of assymetry, including having one freshly reconstructed knee and one nonreconstructed knee, at any point in time) and reduced time consumed in rehabilitation (given that both knees can be exercised simultaneously, and so the overall time spent in rehab would theoretically be halved; therefore one could anticipate a sooner return to sports). Many people with bilateral ACL tearing have staggered ACL reconstructions, but some go the simulataneous route. (The founder of Bob's ACL WWWBoard, software developer Bob Willmot, tore both ACLs simultaneously in an alpine-skiing accident but underwent staggered ACL reconstructions; however, keep in mind that this was back in 1996.) Note that if the bilateral ACL tearing is accompanied by meniscal tearing (especially if the meniscal tearing is also bilateral), and if said meniscal tears are repaired (as they should be; note that repair is far superior to partial menisectomy), then being non-weight-bearing for a number of weeks will be indicated...and in such a case, having surgery on both knees at the same time would present heightened postoperative mobility concerns. (In this study, no one underwent meniscal repair.) As with all knee surgeries, these are issues to discuss in depth with both one's orthopedic surgeon and one's physiotherapist.

ABSTRACT

Background: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL) deficiency remains controversial.

Purpose: To evaluate cost and early functional results after bilateral ACL reconstruction at a single setting.

Study Design: Retrospective review.

Methods: Eleven patients (22 knees) who underwent bilateral ACL reconstruction at a single setting were compared with 33 patients (35 knees) who underwent unilateral ACL reconstruction during the same time period.

Results: The mean time to full unrestricted activity between groups was 6.5 months for both groups (P = 0.92). There were no significant differences between groups at latest follow-up for complication rates or laxity as judged by Lachman test, pivot shift test, and KT 1000 arthrometry. The mean International Knee Documentation Committee subjective score at a mean 3.1-year follow-up was 91.9 for the bilateral ACL group compared to 92.0 for the unilateral ACL group (P = 0.95). There was a total cost savings per knee (based on 2001 dollars) of $3751.59 when performing bilateral ACL reconstruction at a single setting (P = 0.0001).

Conclusions: For patients presenting with bilateral ACL deficient knees, reconstruction of both knees at a single setting is safe, cost effective, and does not appear to compromise early functional results.

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