Effect of Drain Placed in the Donor Site in the Early Postoperative Period After Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction With Quadrupled Hamstring Tendons

Abstract

Background: No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons.

Hypothesis: Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain).

Results: In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84° vs 69°, P < .05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P < .05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P < .05), 5 (32.7 vs 36.0 cm, P < .05), and 7 (31.8 vs 35.7 cm, P < .001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, P = .001), 5 (38.46 vs 60.35, P = .001), and 7 (38.07 vs 61.43, P = .001).

Conclusion: Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week.

Keywords

postoperative drain anterior cruciate ligament (ACL) reconstruction donor site visual analog scale (VAS)

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References

Acus RW

Clark JM

Gradisar IA

Kovacik MW

. The use of postoperative suction drainage in total hip arthroplasty. Orthopedics. 1992;15:1325-1328.

Beer KJ

Lombardi AV

Maliory TH

Vaughn BK

. The efficacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg Am. 1991;73:584-587.

Bohy B

Feyen J

Smits P

Nuyts R.

Bone wax as a way to prevent hematoma after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2002;18:E45.

Brown CH Jr

Steiner ME

Carson EW

. The use of hamstring tendons for anterior cruciate ligament reconstruction: technique and results. Clin Sports Med. 1993;12:723-756.

Canty SJ

Shepard GJ

Ryan WG

Banks AJ

. Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members. Knee. 2003;10:385-387.

Chandratreya A

Giannikas K

Livesley P.

To drain or not drain: literature versus practice. J R Coll Surg Edinb. 1998;43:404-406.

Cobb JP

. Why use drains?J Bone Joint Surg Br. 1990;72:993-995.

Coupens SD

Yates CK

. The effect of tourniquet use and hemovac drainage on postoperative hemarthrosis. Arthroscopy. 1991;7:278-282.

Cruse PJE

Foord R.

A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206-210.

10.

Dhawan A

Doukas WC

Papazis JA

Scoville CR

. Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Am J Sports Med. 2003;31:419-424.

11.

Drinkwater CJ

Neil MJ

. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty. 1995;10:185-189.

12.

Graham SM

Parker RD

. Anterior cruciate ligament reconstruction using hamstring tendon grafts. Clin Orthop. 2002;402:64-75.

13.

Hallstrom BR

Steele JF

. Postoperative course after total hip arthroplasty: wound drainage versus no drainage. Orthop Rev. 1992;21:847-851.

14.

Karahan M.

Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft [letter to the editor]. Am J Sports Med. 2003;31:419-424.

15.

Parker MJ

Roberts C.

Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2001;4:CD001825.

16.

Reilly TJ

Gradisar IA

Paken W

Reilly M.

The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop. 1986;208:238-242.

17.

Ritter MA

Keating EM

Faris PM

. Closed wound drainage in total hip and total knee replacement: a prospective randomized trial. J Bone Joint Surg Am. 1994;76:35-38.

18.

Shelbourne KD

Nitz P.

Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 1990;18:292-299.

19.

Slappendel R

Weber EW

Benraad B

Dirksen R

Bugter ML

. Does ibuprofen increase perioperative blood loss during hip arthroplasty?Eur J Anaesthesiol. 2002;19:829-831.

20.

Soderberg GL

Ballantyne BT

Kestel LL

. Reliability of lower extremity girth measurements after anterior cruciate ligament reconstruction. Physiother Res Int. 1996;1:7-16.

21.

Straw R

Colclough K

Geutjens GG

. Arthroscopically assisted ACL reconstruction: is a drain necessary?Knee. 2003;10:283-285.

22.

Waugh TR

Stinchfield FE

. Suction drainage of orthopaedic wounds. J Bone Joint Surg Am. 1961;43:939-946.

23.

Willett KM

Simmons CD

Bentley G.

The effect of suction drains after total hip replacement. J Bone Joint Surg Br. 1988;70:607-610.

24.

Williams RJ III

Laurencin CT

Warren RF

Speciale AC

Brause BD

O’Brien S.

Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: diagnosis and management. Am J Sports Med. 1997;25:261-267.