Page 38 - ISAKOS 2021 Newsletter Volume 1

CURRENT CONCEPTS
ACL Reconstruction 2020: A Worldwide Survey
Maria Tuca, MD
Clinica Alemana – Universidad del Desarrollo, Hospital Clinico Mutual de Seguridad, Santiago, CHILE
Brett A. Fritsch, MBBS, BSc(Med), FRACS, FAOrthA
Sydney Orthopaedic Research Institute, North Shore Knee Clinic,
Sydney, AUSTRALIA
Riccardo Cristiani, MD
Capio Artro Clinic, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, SWEDEN
Horacio F. Rivarola-Etcheto, MD
Hospital Universitario Austral Buenos Aires, ARGENTINA
Seth L. Sherman, MD
Stanford University, California, UNITED STATES
Andy Williams, MBBS, FRCS(Orth), FFSEM(UK)
Fortius Clinic, London,
UNITED KINGDOM
Karl Eriksson, MD, PhD
Stockholm South Hospital, Karolinska Institutet, Stockholm, SWEDEN
Introduction
Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed surgical procedures involving the knee, with an extensive amount of literature dedicated to its research. Still, there is no consensus regarding the technical aspects of the surgical procedure (e.g., technique, graft choice, fixation method, and so on). Surgeons plan their ACLR procedures on the basis of their own personal experience, the available evidence, the preferences of their peers, and local trends. To date, several local surveys have summarized the current trends and common practices for ACLR in different countries1,2. To our knowledge, none of the previous ACL surveys have evaluated surgeons’ preferences worldwide.
The Survey: Methods & Results
The ISAKOS Knee Sports & Preservation Committee conducted an online survey comprising 16 questions regarding selected issues related to ACLR. The survey was sent out to all ISAKOS Members during May 2020 (Fig. N.1). Of the 3,026 questionnaires that were delivered, 2,130 were completed (response rate, 70.4%), representing the largest ACLR survey reported to date. The numbers of answered questionnaires according to region were as follows: Asia & Oceania, 949 (45%); Central and South America, 532 (25%); Europe, 382 (18%); North America, 238 (11%); and Africa, 29 (1%). The main findings of this survey are summarized in Table I. Hamstrings autograft was the leading option for primary ACLR (64% of surgeons), followed by patellar tendon (21%). A medial portal drilling technique for the femoral tunnel was preferred by 78% of surgeons. Cortical buttons were the favored option for femoral fixation of hamstring grafts (82% of surgeons), and bioabsorbable screws were the favored option for the tibia (62%). For both tibial and femoral fixation of patellar tendon grafts, the preferences were split between metallic screws (45% for the femur and 47% for the tibia) and bioabsorbable screws (38% for the femur and 48% for the tibia). Prophylactic antibiotic soaking of the graft was endorsed by 45% of surgeons, and graft pre-tensioning was endorsed by 64%. The majority (57%) of surgeons positioned the knee between 10° and 30° of flexion and neutral rotation for graft fixation, and return to play was permitted at an average of 9.1 months. An anterolateral augmentation (or extra-articular tenodesis) was added to 10% of primary and isolated ACLRs and 36% of revision ACLRs. More than half (55%) of the responders indicated that they used a postoperative brace for isolated ACLR, and the average time for return to play was 9 months.
36 ISAKOS NEWSLETTER 2021: VOLUME I