Steep Learning Curve for ACL Surgery

Adapted from the Fall 2012 issue of Discovery to Recovery


Providing further evidence that practice makes perfect when it comes to surgeries, a new study of anterior cruciate ligament (ACL) reconstruction finds that patients who have their ACL reconstructed by surgeons who have performed fewer than 60 surgeries are roughly four to five times more likely to undergo a subsequent ACL reconstruction.

 “We may not be training our sports medicine specialists well enough to perform this complex procedure if the learning curve is still this steep after finishing their fellowship,” says senior author Stephen Lyman, PhD, director of Epidemiology and Biostatistics at HSS, who presented the study at the 2012 annual meeting of the American Academy of Orthopedic Surgeons.

The findings come from an analysis of a New York State Department of Health database. The study includes all ACL reconstructions performed between 1997 and 2006 by surgeons who performed their first reconstruction in 1997 or later. Controlling for patient factors such as age and comorbidities, the scientists examined whether there was an association between a patient having a subsequent ACL surgery and how many cases a surgeon had performed: 10 or fewer, 11-60, 61-120, or 121-150.

For many procedures, surgeons are expected to gain clinical competency after 10 cases, but the investigators identified a much steeper learning curve for ACL reconstruction. For example, if a patient fell between case 11 and 60 of a surgeon’s career, they were 3.7 times more likely to have a subsequent surgery than if they fell in a case over 150.

“Although fairly routine, ACL reconstruction is a complex procedure that has many potential pitfalls,” says Robert Marx, MD, an attending orthopedic surgeon on the HSS Sports Medicine and Shoulder Service and co-author. “While the relationship between surgical volume and outcome has been well established, these data indicate that we need to continue to improve the way we train surgeons.”

Read the full Discovery to Recovery Fall 2012 issue.


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