Patients interested in having torn ACLs fixed properly the first time should make sure their surgeons have performed at least 60 repairs, according to research presented at the annual meeting of the American Academy of Orthopaedic Surgeons in San Francisco.
ACL reconstructions performed by surgeons who have not passed the 60-case threshold are 4 to 5 times more likely to require subsequent revision, say the study's authors. They based their findings on nearly 13,000 reconstructions performed between 1997 and 2006 in hospitals and ASCs throughout the state of New York.
Even fellowship training in an orthopedic subspecialty does not shorten the procedure's learning curve for young surgeons, which goes against conventional wisdom, says Robert Marx, MD, co-author of the study and an orthopedic surgeon at the Hospital for Special Surgery in New York City.
Dr. Marx points out that ACL repair is a complex procedure with many technically challenging surgical steps.
To improve the outcomes of novice surgeons, he suggests they should be evaluated differently during schooling, given more autonomy at the end of training or practice on surgical simulators before entering surgery's real world. "Ultimately, the true learning is in practice," he says. "Maybe we need to rethink how we train our surgeons in light of this."
Daniel Cook
