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2025 ISAKOS Biennial Congress ePoster

The Effect Of Closed Suction Drain In Early Postoperative Period After Arthroscopic Acl Reconstruction (Aclr) - A Randomized Control Trial

Sujith B S, MS, FNB, Visakhapatnam , Andhra Pradesh INDIA
Sundararajan Silvampatti Ramasamy, MS , Coimbatore, Tamil Nadu INDIA
Ganga Hospital and Medical Centre, Coimbatore, Tamil Nadu, INDIA

FDA Status Not Applicable

Summary

With increasing trends of early Arthroscopic ACL reconstruction, there is potential risk of hematoma especially in acute and subacute ACL injuries. So, there is need to revisit use of suction drains after ACLR. Though this study doesn't recommend routine use of drains after ACLR, but its prudent to consider in acute and subacute ACL injuries.

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Abstract

Background

Recent studies emphasizing superior functional outcomes after ACL injuries with early ACLR than delayed ACLR, there is need to revisit the need for usage of suction drains after ACLR especially in acute and subacute ACL injuries as there are higher chances of post operative hematoma in this subset of patients.

Hypothesis

The usage of closed suction drain reduces post operative knee swelling and hasten return of knee motion in early post operative period after ACLR in acute and subacute ACL injuries.
STUDY DESIGN: Prospective Randomized controlled Trial.

Methods

112 consecutive patients of ACL and with or without meniscal injuries were included in a prospective randomized controlled trial (RCT) between Sept 2023 and Mar 2024. Computer generated randomization done into two groups Group 1 (Drain) = 58 and Group 2 (No drain) = 54. In both groups, ACL reconstruction was done with autologous hamstring graft, meniscal injuries managed appropriately and suction drain placed in the suprapatellar region in Group 1. Drain output noted and was removed bedside after 24 hrs. Vas scores and fall in Hemoglobin levels noted on POD 1; Grade of effusion and thigh conference were noted pre operatively, POD 1, POD 10 and POD 30; Extension loss and knee flexion were noted on POD 10 and POD 30. Subgroup analysis was performed to asses effect of suction drain in early ACLR (duration of symptoms < 3 weeks).

Results

Average age–Group1-35.37±12.34yrs, group2-39.6±11.67yrs, Sex(M:F)-78:34 patients, Mean duration of symptoms Group I: 118 ± 10.2 days and Group II: 106 ± 8.3 days. Early vs delayed ACLR - 46:66 patients. Among both the groups (I vs II)- No statistically significant difference in POD 1 VAS score (3.6vs4.1, P =0.23) and fall in Hb (0.5vs0.3, P=0.73); no difference in Grade of effusion at POD 1 (2.7vs2.9, P=0.61), POD 10 (1.8vs2.1, P=0.82) and POD 30 (0.9vs 1.1, P=0.76); no difference in thigh conference (in cms) at POD 1 ( 1.6vs1.8, P =0.07), POD 10 (0.9vs1.1, P= 0.23) and POD 30 (0.6vs0.7, P =0.57); no difference in extension loss at POD 10 (8o vs 12o,P= 0.87) and POD 30 (5o vs 8o,P= 0.15) and also in knee flexion at POD 10 (72o vs 69o,P= 0.72) and POD 30 (121o vs 112o P=0.45).
Subgroup analysis was performed among patients with duration of symptoms less than 3 weeks (Early ACLR) = 46 patients: Group Ia (Drain) – 24 and Group IIa (No Drain) – 22. There was statistically significant difference among two subgroups (Ia vs IIa) at POD 1 in thigh circumference (cms) (1.1 vs 2.9, P =0.04) and grade of effusion (1.8 vs 2.9, P =0.03) Also, higher extension loss at POD 10 in group IIa (9o vs 16o, P= 0.04), but no difference in outcome at POD 30 among both groups.
The patients who underwent early ACLR without drain had higher difference in thigh circumference and greater effusion on POD 1, also marginally higher loss of extension at POD 10.

Conclusion

The routine use of closed suction drain after ACLR is not warranted, though its prudent to consider use of drains in acute and subacute ACL injuries.

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