title: Limited utility of routine early postoperative radiography after primary ACL reconstruction.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA. Electronic address: bcw4x@virginia.edu.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: M Tyrrell
authors.initials: MT
authors.lastname: Burrus
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kew
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Dempsey
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: F Winston
authors.initials: FW
authors.lastname: Gwathmey
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA 22908, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Diduch
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging* / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D011184:Postoperative Period; D011859:Radiography / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
keywords: ACL reconstruction; Cost-effective; Healthcare economics; Radiographs; X-ray