Limited utility of routine early postoperative radiography after primary ACL reconstruction

Given the overall success of anterior cruciate ligament (ACL) reconstruction and the infrequent occurrence of complications detectable on radiographs, the clinical utility and cost-effectiveness of routine radiographs in the early postoperative setting is questionable.

Nine hundred thirty-three consecutive adult patients undergoing uncomplicated ACL reconstruction at a single institution were retrospectively reviewed to determine whether a postoperative knee radiograph was obtained within the first three months postoperatively. Images, reports and clinical notes were reviewed to determine if any clinical management change occurred due to x-ray findings. Radiograph charges, including imaging, technical and professional charges were calculated.

Five hundred ninety-nine of 933 primary ACL reconstruction patients (64.8%) had postoperative knee radiography at an average of 6.3±3.5 weeks postoperatively. A musculoskeletal radiologist read 97.7% of x-rays as normal. In the associated visit note, 70.3% of x-ray results were documented. Only 14.1% of patients with a postoperative x-ray had subsequent imaging. There were no significant management changes based on the routine postoperative radiographs using the defined criteria. A total of $336,683 ($562 per patient) was billed to patients for postoperative radiographs.

Routine early postoperative radiography after primary ACL reconstruction is of questionable utility. The significant per-patient expense is not balanced by the low yield of clinically meaningful data, as nearly all radiographs in the present series were normal and none resulted in significant changes in postoperative clinical management. These results suggest that routine radiographs after uncomplicated ACL reconstruction may be unnecessary although larger, multicenter studies are necessary to confirm these findings.

Level IV, retrospective case series.