Background

The primary goal of clinical research is to ascertain insights into outcomes of treatments and interventions that lead to improved patient care. The value of a clinical registry lies in prospectively capturing a large cohort of patients and monitoring their outcomes over time. We sought to measure the impact of research on clinical practice resulting in measurable adoption and improved patient care based on findings from a clinical registry to reduce allograft utilization for primary anterior cruciate ligament reconstruction (ACLR) within a US integrated health care system.

Methods

We conducted a research study using data from the Kaiser Permanente ACLR registry. Patients who underwent primary isolated unilateral ACLR using either an allograft, bone-patellar tendon-bone autograft (BPTB), or hamstring autograft from January 1, 2007 through December 31, 2017 were included in the study sample. To determine the potential impact of our allograft reduction program, we performed an interrupted time series analysis evaluating two-year revision rates using Poisson regression and segmented regression.

Results

The identified study sample comprised 30,768 primary ACLR performed by 328 surgeons at 48 healthcare centers. There were 15 and 29 quarters included in the pre- and post-intervention periods, respectively. Overall, allograft utilization increased 28.3% during the pre-intervention period but decreased 52.3% in the post-intervention period. Poisson regression analysis found a higher two-year revision risk per quarter pre-intervention (relative risk [RR]=1.04, 95% confidence interval [CI]=1.02, 1.07) and lower risk post-intervention (RR=0.95, 95% CI=0.92, 0.98). In segmented regression an increasing trend in the estimated two-year revision rate of 0.10% (95% CI=0.09, 0.11) per quarter prior to the intervention and a decreasing trend of 0.13% (95% CI=-0.14, -0.12) per quarter after the intervention. Assuming continuation of pre-intervention trends, this intervention is estimated to have prevented 741 revisions over the post-intervention period.

Conclusion

Information derived from a clinical registry and disseminated to participating clinicians can directly influence the use of specific procedures or implants in clinical practice and lead to better outcomes for patients.