Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA

Acta Orthop. 2012 Dec;83(6):577-82. doi: 10.3109/17453674.2012.741451. Epub 2012 Nov 1.


Background and purpose: Patient and implant registries are important clinical tools in monitoring and benchmarking quality of care. For comparisons amongst registries to be valid, a common data set with comparable definitions is necessary. In this study we compared the patients in the Norwegian Knee Ligament Registry (NKLR) and the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry (KP ACLRR) with regard to intraarticular findings, procedures, and graft fixation characteristics reported by the operating surgeon for both primary and revision anterior cruciate ligament reconstructions (ACLRs).

Methods: We performed a cross-sectional comparison of the NKLR and KP ACLRR cohorts registered between 2005 and 2010. Aggregate-level data including patient characteristics (age, sex, and laterality), meniscal and cartilage injury patterns and corresponding treatment procedures, choice of graft, and fixation characteristics (type and component material) were shared between registries. Descriptive analyses were then conducted.

Results: During the study period, 11,217 ACLRs were registered in the NKLR and 11,050 were registered in the KP ACLRR. In the NKLR, hamstring autograft was used more (68% vs. 30%) for primary ACLRs and allograft was used less (0.2% vs. 41%) than in the KP ACLRR. The KP ACLRR reports more meniscal tears among both primary and revision ACLRs (63% and 50% vs. 49% and 36%). The NKLR reports less use of biodegradable fixation devices.

Conclusions: Baseline findings between the NKLR and the KP ACLRR were congruent regarding patient characteristics and most injury patterns, adding to the evidence that comparisons and collaborations between these registries will provide generalizable information to the international orthopedic community. The variation in the treatment, including graft and implant selection and meniscus procedures, between the 2 registries provides opportunities to explore the impact of treatment choices on the outcomes of ACLRs.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Anterior Cruciate Ligament Reconstruction / statistics & numerical data*
  • Cross-Sectional Studies
  • Cultural Characteristics
  • Female
  • Follow-Up Studies
  • Geography
  • Humans
  • Incidence
  • Injury Severity Score
  • Intraoperative Complications / diagnosis*
  • Knee Injuries / epidemiology
  • Knee Injuries / surgery
  • Male
  • Monitoring, Intraoperative / methods
  • Norway
  • Registries*
  • Risk Assessment
  • Sex Factors
  • Treatment Outcome
  • United States
  • Young Adult