Hemoglobin A1c Levels >6.6% Are Associated With Higher Postoperative Complications After Anterior Cruciate Ligament
Ophelie Lavoie-Gagne1, Varun Nukala1, Eric M Berkson1
1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Insights
Patients with diabetes undergoing anterior cruciate ligament reconstruction (ACLR) and a hemoglobin A1c (HbA1c) level of 6.7% or higher face a significantly increased risk of postoperative complications. Strict glycemic control is recommended to minimize these risks.
Area of Science:
- Orthopedic surgery
- Diabetology
- Biochemistry
Background:
- Diabetes mellitus is a prevalent condition associated with impaired wound healing and increased infection risk.
- Glycemic control, measured by hemoglobin A1c (HbA1c), is a key indicator of long-term blood sugar management.
- Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure with potential postoperative complications.
Purpose of the Study:
- To investigate the association between preoperative hemoglobin A1c (HbA1c) levels and the incidence of postoperative complications following primary anterior cruciate ligament reconstruction (ACLR).
Main Methods:
- Retrospective review of 19 diabetic patients undergoing primary ACLR between 2000 and 2019.
- Data collection included demographics, surgical details, HbA1c levels (within 90 days preoperatively), and 90-day postoperative complications.
- Statistical analysis involved receiver operating curve (ROC) analysis to identify an optimal HbA1c cutoff and multivariable logistic regression.
Main Results:
- Patients with an HbA1c of 6.7% or higher were 25 times more likely to experience any postoperative complication (P = .04).
- An elevated HbA1c (≥6.7%) was significantly associated with arthrofibrosis (P = .02) and septic knee (P = .04) on multivariable analysis.
- Complications included septic knee (n=1) and cyclops lesions requiring arthroscopic lysis (n=3).
Conclusions:
- Preoperative HbA1c levels ≥6.7% in diabetic patients undergoing primary ACLR are significantly associated with an increased risk of postoperative complications, including arthrofibrosis and infection.
- These findings suggest that strict glycemic control prior to ACLR may be crucial for minimizing adverse outcomes.
- The study highlights the importance of considering glycemic status in the preoperative assessment of diabetic patients undergoing knee ligament reconstruction.
Purpose:
To investigate the relation between hemoglobin A1c (HbA1c) levels and postoperative complications after primary anterior cruciate ligament reconstruction (ACLR).
Methods:
A retrospective review was performed of consecutive patients with an isolated anterior cruciate ligament tear, preoperative diagnosis of diabetes, and documented HbA1c within 90 days of primary ACLR between 2000 and 2019. Data collected included demographic and surgical characteristics, 90-day medical complications, and subsequent surgeries on the ipsilateral knee. A receiver operating curve was constructed for each HbA1c level in relation to postoperative complications and the optimal cutoff identified via Youden's J statistic. Multivariable logistic regression was performed to assess the relation between postoperative complications and age, sex, graft type, diabetes subtype, and HbA1c.
Results:
Nineteen patients (7 females, 12 males) fulfilled inclusion criteria with preoperative HbA1c ranging from 5.5 to 10. Complications included septic knee (n = 1) and cyclops lesions requiring arthroscopic lysis (n = 3). Patients with HbA1c of 6.7% or higher were 25 times more likely to experience any postoperative complication (P = .04) and 16 times more likely to require lysis of adhesions (P = .08). On multivariable regression, HbA1c remained significantly associated with any complication (P = .005) and developing arthrofibrosis (P = .02) independent of age, sex, graft type, and diabetes subtype.
Conclusions:
Diabetic patients undergoing primary ACLR with a preoperative HbA1c of 6.7% or higher were 25 times more likely to require repeat surgical intervention for a postoperative complication. These complications included arthrofibrosis and infection. Strict glycemic control may help minimize the risk of postoperative complications after ACLR.
Level Of Evidence:
Level III, retrospective cohort study.
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