2021 ISAKOS Biennial Congress Paper
Same Knee, Different Goals: Patients and Surgeons have Different Priorities Related to ACL Reconstructions and Surgeons are Resistant to Changing Clinical Practice
Hana Marmura, BSc, London, ON CANADA
Dianne M. Bryant, PhD, London, ON CANADA
Trevor B. Birmingham, PT, PhD, London, Ontario CANADA
Kurt Paul Spindler, MD, Hillsboro Beach, FL UNITED STATES
Christopher C. Kaeding, MD, Columbus, OH UNITED STATES
Tim Spalding, FRCS(Orth), Leamington Spa, Warwickshire UNITED KINGDOM
Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, London, ON CANADA
University of Western Ontario, London, Ontario, CANADA
FDA Status Not Applicable
Summary
An exploration of patients’ and surgeons’ priorities related to anterior cruciate ligament reconstructions, and the magnitude of treatment effects in evidence that may influence surgical practice change.
Abstract
Background
The priorities of patients should be shared by those treating them. Patients and surgeons are likely to have different priorities surrounding anterior cruciate ligament reconstruction (ACLR), with implications for shared decision-making and patient education. The optimal surgical approach for ACLR is constantly evolving, and the magnitude of treatment effect necessary for evidence to change surgical practice is unknown.
Purpose
The aim of this study was to determine 1) the priorities of surgeons and patients when making decisions regarding ACLR and 2) the magnitude of reduction in ACLR graft failure risk that orthopaedic surgeons require before changing practice.
Methods
This study followed a cross-sectional survey design. Three distinct electronic surveys were administered to pre-operative ACLR patients, post-operative ACLR patients, and orthopaedic surgeons in the ACL Study Group. Patients and surgeons were asked about the importance of various outcomes and considerations pertaining to ACLR. Surgeons were asked scenario-based questions regarding changing practice for ACLR based on new research.
Results
Surgeons were more likely to prioritize outcomes related to the surgical knee itself, whereas patients were more likely to prioritize outcomes related to their daily lifestyle and activities. Knee instability and risk of re-injury were unanimous top priorities among all three groups. A mean relative risk reduction in ACLR graft failure of about 50% was required by orthopaedic surgeons to change practice regardless of the type of change, or patient risk profile.
Conclusion
There are discrepancies between the priorities of surgeons and patients, and orthopaedic surgeons appear resistant to changing practice for ACLR.