Hot Knee Services Significantly Reduce Listing Times for Anterior Cruciate Ligament Reconstruction: An Analysis of Acl Reconstructions at Betsi Cadwaladr University Health Board (Bcuhb)

Delayed ACL reconstruction is associated with an increased risk of meniscal tears and early osteoarthritis. To reduce this risk, a hot knee service (HKS) was implemented at Wrexham Maelor Hospital (WMH) to allow for rapid assessment, scanning, and prompt surgical management where indicated, through twice weekly clinics, and fortnightly lists. The authors sought to determine whether this reduced times for ACL reconstruction at WMH compared with other BCHUB hospitals - Ysbyty Glan Clwyd (YGC) and Ysbyty Gwynedd (YBG). Retrospective analysis of all ACL reconstructions performed over 2 years’ across four hospitals in BCUHB, identifying the dates of injury, first clinic attendance, MRI scan, listing and surgery. Patients were divided into parent hospitals (WMH, YGC, YBG), with WMH further subdivided into elective and HKS, with time from to surgery from each point determined. HKS patients (39.7 days), and WMH overall (81.9 days) had significantly reduced times from listing to surgery, compared with YGC and YBG (238.3, 237.2 days respectively [p<0.001]). Time from first clinic attendance to surgery was also significantly lower (147.3), compared with YGC and YBG (320.5, 375.1 respectively, [p<0.001]). Implementation of the HKS at WMH resulted in significantly lower times to surgery for patients with ACL rupture, resulting in more rapid assessment and surgical management of ACL rupture, potentially preventing progression of osteoarthritis and concomitant meniscal injury in these patients.