Page 43 - ISAKOS 2021 Newsletter Volume 1
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The rates of usage of quadriceps tendon graft and allograft for ACLR were slightly lower in the Argentinian registry (2.5% and 1.5%, respectively) than in the ISAKOS survey (5% and 4%, respectively). While transtibial drilling is still common in the Argentinian registry (28%), a low incidence was reported in the worldwide registry (11%). There is little experience with retro-drilling technique in Argentina (1% compared with 10.5% worldwide), mainly because of the high costs. There is no record of surgeon case volume, graft pretensioning, antibiotic solution graft presoaking, or knee positioning for graft fixation in the Argentinian registry.
Reflections and Summary
Looking at the comparison between the ISAKOS survey and the local / regional summaries, there is no doubt that similarities are more common than differences. One obvious reason for this finding is the globalization of medicine as reflected by international collaboration and the ISAKOS mission itself. Surely, key opinion leaders in different parts of the world have influenced tactics in graft choice and fixation methods to some extent, but the conformity that this survey reflects is still a state of the art and consensus proposal in itself. Furthermore, the majority (approximately 80%) of the survey respondents performed >25 ACLRs per year and 50% performed >50 ACLRs per year, reflecting a good level of experience among the respondents who in many regions likely serve as key opinion leaders.
Some strategies have definitely changed over the years. For example, medial portal drilling demonstrated a high prevalence across surveys and registries. Other treatment tactics that have gained popularity over the last years include the use of vancomycin for soaking the graft and adding an anterolateral procedure in ACLRs. Surprisingly, half of the surgeons still increase the total cost by using a brace postoperatively after a primary ACL reconstruction, despite the lack of obvious evidence-based benefit.
The definite strengths of the present survey (which we believe to be the largest benchmark study in the world to date) are the high response rate and the high numbers of responses. A potential weakness is that the survey primarily addresses dedicated ACL surgeons and not the great number of surgeons worldwide who do not participate in academic international medicine collaborative work. Nevertheless, most low-volume surgeons are influenced by national key opinion leaders, many of whom are thought to be represented in this survey. The encouraging summary, when looking at the great survey response as well as different continent approximations, is indeed the establishment of a 2020 reference platform for current and future comparisons.
NOTE: The authors would like to thank and acknowledge the ISAKOS Knee Sports & Preservation Committee members listed below who assisted us in reaching out to their respective regions for greater survey participation by orthopaedic surgeons. Furthermore we gratefully acknowledge all international participants who took the survey and contributed to the results. Thank you!
1 Karl Eriksson, MD, PhD SWEDEN, Chair
2 Sachin R. Tapasvi, MBBS, MS, DNB, FRCS INDIA,
Deputy Chair
3 Nobuo Adachi, MD, PhD JAPAN
4 Björn Barenius, MD, PhD SWEDEN
5 Riccardo Cristiani, MD SWEDEN
6 Marco K. Demange, MD, PhD BRAZIL
7 Niklaus F. Friederich, MD, SWITZERLAND
8 Brett A. Fritsch, MBBS, BMedSc AUSTRALIA
9 Alan Getgood, MD, FRCS(Tr&Orth), DipSEM CANADA
10 Timothy Lording, MBBS, FRACS AUSTRALIA
11 Jeffrey A. Macalena, MD UNITED STATES
12 Robert A. Magnussen, MD, MPh UNITED STATES
13 Andrew D. Pearle, MD UNITED STATES
14 Horacio F. Rivarola-Etcheto, MD ARGENTINA
15 Seth L. Sherman, MD UNITED STATES
16 Maria Tuca, MD CHILE
18 Mark G. Clatworthy, FRACS NEW ZEALAND References
1. New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years. Alberto Grassi, Christian Carulli,2 Matteo Innocenti, Massimiliano Mosca, Stefano Zaffagnini,1 Corrado Bait. Joints. 2018 Sep; 6(3): 177–187 2. Emerging Trends in Anterior Cruciate Ligament Reconstruction Jacob Budny, Joseph Fox, Michael Rauh, Marc Fineberg J Knee Surg 2017 Jan;30(1):63-69. doi: 10.1055/s-0036-1579788. Epub 2016 Mar 28. 3. Ha JK, Kim JG, Jun DJ, Kim SB, Kim ST. A survey on anterior cruciate ligament reconstruction: an Asian perspective. AOSM 2016;3:59-66.

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