Intra-articular drain versus no drain after arthroscopic anterior cruciate ligament reconstruction: a randomized, prospective clinical trial.
OBJECTIVE
A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. The usual reason given to justify the use of a drain is to minimize patient pain and stiffness of the knee joint. The purpose of this study was to assess the validity of this approach.


METHODS
In this study 118 consecutive ACL reconstruction patients were randomized to no drain or a postoperative intra-articular suction drain. Inclusion criteria included a successful ACL reconstruction via either 4-strand hamstrings or bone-patellar tendon-bone autograft as a graft source. The primary outcomes were defined as pain (assessed by pain scores and analgesic counts) and range of motion (ROM) (assessed by loss of flexion and extension compared with the nonoperative leg). An independent statistical analysis was performed.


RESULTS
The 2 groups were comparable with respect to patient demographics, surgical findings, and procedures performed. There were no differences between the treatment groups for the primary outcomes of pain and ROM during the 8-week follow-up period. The study had adequate power to detect a clinically significant difference. Regarding the secondary outcomes, there was a difference in the grade of hemarthrosis between the groups at week 1 but not at week 4 or 8. However, the difference in subjective grade of hemarthrosis at 1 week did not have any effect on the primary outcomes of pain and ROM. During the study period, there were no complications in either group.


CONCLUSIONS
The routine use of intra-articular drains after arthroscopic ACL surgery was not supported by this study.


METHODS
Level II, randomized controlled trial without narrow confidence intervals.
McCormack
Robert G
RG
Department of Orthopedic Surgery, University of British Columbia, New Westminster, British Columbia, Canada. mccormac@interchange.ubc.ca
Greenhow
Robert J
RJ
Fogagnolo
Fabricio
F
Shrier
Ian
I
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D018771:Arthralgia / Q000209:etiology / Q000517:prevention & control; D001182:Arthroscopy / Q000009:adverse effects*; D016025:Bone Transplantation; D004322:Drainage; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013710:Tendons / Q000637:transplantation; D016896:Treatment Outcome