Outpatient anterior cruciate ligament reconstruction: an analysis of charges and perioperative complications.

All outpatient anterior cruciate ligament (ACL) reconstructions using patellar tendon autograft performed at an accredited outpatient surgical center between 1994 and 1998 were prospectively studied. Hospital charges pertaining to the procedures were examined, and perioperative morbidities that might be attributed to an outpatient procedure were evaluated. The study group comprised 284 patients; average patient age at surgery was 28.7 years. Patients were subgrouped into group 1 (isolated ACL reconstructions; n=163), group 2 (ACL reconstructions and meniscal repair; n=48), and group 3 (ACL reconstructions and partial meniscectomy; n=73). Surgicenter facility charges, reoperation rate, complication rate, motion, pain management, hospital emergency room visits, hospital admission, and outpatient surgical facility visits were analyzed. Historical controls from our hospital and our initial outpatient pilot study (May 1994 through November 1995) were used as financial controls. The average surgical center charge for all patients was $3,443. On average, there was a $600 increase for all subgroups from May 1994 through November 1995 compared to December 1995 through August 1998. In the latter time interval, the fixed facility charges were $3,150, $4,075, and $4,275 for groups 1, 2, and 3, respectively. Overall, 19 (7%) patients required a reoperation including 7 (2.5%) patients who required arthroscopic debridement for symptomatic motion deficits. This study expands on our initial published report regarding hospital charges pertaining to an outpatient ACL reconstruction. Extended over another 4 years, we noted slight increases reflective of regional inflationary increases. Compared to our initial inpatient study (1988-1993), significant charge reductions were maintained. This study demonstrated a low complication rate and high patient subjective satisfaction level.

Interbacterial binding among strains of pathogenic and commensal oral bacterial species.

Strong interspecies adherence was demonstrated among the periodontal pathogens Treponema denticola, Bacteroides forsythus and Porphyromonas gingivalis, and between these pathogens and the commensal plaque organism Streptococcus crista. Adherence showed specificity and demonstrated saturation binding kinetics. Binding between B. forsythus and P. gingivalis appeared to be a unimodal protein-protein interaction. Binding between the other organisms was at least bimodal involving interactions between combinations of proteins and carbohydrates with a variety of sugar specificities. Salivary molecules prevented adherence between T. denticola and S. crista, and serum eliminated B. forsythus binding to P. gingivalis. All other interactions occurred to some degree in the presence of serum and saliva. Such interbacterial binding interactions may be important in the establishment of periodontopathic plaque.