Marx Robert G, Jones Edward C, Angel Michael, Wickiewicz Thomas L, Warren Russell F
Center for Clinical Outcome Research, Hospital for Special Surgery, New York, New York 10021, USA.
Arthroscopy. 2003 Sep;19(7):762-70. doi: 10.1016/s0749-8063(03)00398-0.
The purpose of the study was to quantify the amount of agreement among orthopaedic surgeons regarding the natural history of the anterior cruciate ligament (ACL)-deficient knee, surgery, and rehabilitation, and the treatment of these patients.
Physician mail survey.
Orthopaedic surgeons were randomly selected from the American Academy of Orthopaedic Surgeons (AAOS) directory. Only individuals who treated or referred ACL-insufficient patients for treatment within the past year were asked to complete the 3-page survey. The survey included 25 questions regarding clinical opinion. Clinical agreement was present when 80% or more of the surgeons agreed on the same response option.
The total number of surgeons who responded to the survey was 397 (response rate, 54.8%) and the number who had treated or referred ACL-insufficient patients in the past year was 261. Among surgeons who completed the questionnaire, the response rates to the individual questions ranged from 92% to 100%. The mean response rate for all questions was 97.4%. The mean age of the surgeons was 48.4 years, and 35.8% considered their practice to be a subspecialty in sports medicine or knee surgery. For 12 questions (48%), there was clinical disagreement among the surgeons. Surgical volume was associated with clinical opinion for 16 of 25 questions (P < or =.05).
Significant variation is seen in clinical opinion and decision-making regarding ACL injuries among members of the AAOS, particularly regarding whether ACL-deficient patients can participate in all recreational sports activities, that ACL reconstruction reduces the rate of arthrosis, and on the use of braces in the postoperative period. Additionally, surgeons disagreed on the effect of 4 patient characteristics (age over 40, presence of pain, irreparable meniscal tear, injury involving Workers' Compensation) on the decision to perform surgery. Areas of significant clinical uncertainty should be the focus of future research and medical education for orthopaedic surgeons who treat ACL injuries.
本研究的目的是量化骨科医生在前交叉韧带（ACL）损伤膝关节的自然史、手术及康复以及这些患者的治疗方面的意见一致性程度。
医生邮件调查。
从美国骨科医师学会（AAOS）名录中随机选取骨科医生。仅邀请在过去一年中治疗或转诊过ACL功能不全患者的个体完成这份3页的调查问卷。该问卷包含25个关于临床意见的问题。当80%或更多的医生对同一回答选项达成一致时，存在临床一致性。
回复调查问卷的医生总数为397名（回复率为54.8%），过去一年中治疗或转诊过ACL功能不全患者的医生有261名。在完成问卷的医生中，各个问题的回复率在92%至100%之间。所有问题的平均回复率为97.4%。医生的平均年龄为48.4岁，35.8%的医生认为他们的业务是运动医学或膝关节手术方面的亚专业。对于12个问题（48%），医生之间存在临床意见分歧。在25个问题中的16个问题上，手术量与临床意见相关（P≤0.05）。
AAOS成员在ACL损伤的临床意见和决策方面存在显著差异，特别是在ACL损伤患者是否可以参加所有娱乐性体育活动、ACL重建是否能降低关节病发生率以及术后是否使用支具方面。此外，医生们在4个患者特征（40岁以上、疼痛、半月板不可修复撕裂、涉及工伤赔偿的损伤）对手术决策的影响上存在分歧。对于治疗ACL损伤的骨科医生而言，重大临床不确定性领域应成为未来研究和医学教育的重点。
