A Learning Curve For Surgeons Doing ACL Repairs

Wall Street Journal Health Blog—February 9, 2012

According to a study presented at a meeting of the American Academy of Orthopaedic Surgeons, there’s a learning curve for surgeons doing repairs of the knee’s anterior cruciate ligament, or ACL.  It was striking to see the actual figures “shown in a fairly dramatic way,” says Robert Marx, an author of the study and an orthopedic surgeon at Hospital for Special Surgery.

The study, which drew from a New York State Department of Health database, found that if a patient’s ACL repair surgery was among the first ten such cases of a surgeon’s career, the patient had about five times the risk of having another ACL repair within a year as a patient whose surgeon had already performed more than 150 of the operations.

As surgeons perform more of a certain procedure, they get better and better at avoiding pitfalls that can take up extra time and in some cases cause major problems and affect outcomes, says Marx. ACL surgery, while routine, is “fairly complex.”

One limitation of the study is that it only tracked further reconstructive surgeries done within a year of the original operation, when a surgeon’s skill could affect the rate of further surgeries years in the future, says Marx. And the data can’t indicate whether the subsequent surgery was done on the same knee as the original operation — though re-operations are usually in the same leg, he says.

Given that a learning curve is to some degree inevitable, what can be done? Marx says it might be possible to supervise surgeries earlier in a physician’s career, or to use medical simulators in training. The study showed a subspecialty fellowship didn’t significantly improve the learning curve, which Marx says may be due to the variability of training programs.

“The bottom line is you can do residency, you can do a fellowship, but at the end of the day you have to go do this on your own,” he says. “There’s no substitute for doing independent surgery.”

Read the full story at WSJ.com.