Southwest Michigan Center for Orthopaedics and Sports Medicine, Saint Joseph, Michigan, USA.
Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Orthop J Sports Med. 2014 Nov 24;2(11):2325967114559892. doi: 10.1177/2325967114559892. eCollection 2014 Nov.
The treatment and rehabilitation procedures of anterior cruciate ligament (ACL) injuries in elite soccer players are controversial. Points of debate include surgical timing, technique, graft choice, rehabilitation, and return-to-sport criteria and timing.
To identify practice preferences among current Major League Soccer (MLS) team orthopaedic surgeons for ACL injuries.
Cross-sectional study; Level of evidence, 4.
The survey was administered at the MLS team physician annual meeting in January 2013. At least 1 orthopaedic surgeon representative from each of the 19 clubs (16 from the United States, 3 from Canada) was in attendance. Teams with more than 1 affiliated orthopaedic surgeon were given an additional survey to be completed either at the meeting or returned via e-mail. Descriptive statistics, Wilcoxon Mann-Whitney (return-to-play parameters, running, and ball drills), and Fisher exact tests (graft selection, bracing, continuous passive motion) were applied to the various data sets from the survey responses.
A 100% survey participation rate was achieved (22 team orthopaedic surgeons representing 19 MLS teams). A single-incision, arthroscopically assisted, single-bundle reconstruction was the most common technique (91%). Surgeons were split regarding femoral tunnel drilling (50% transtibial, 46% accessory medial). Autograft bone-patellar tendon-bone (BPTB) was the most common preferred graft choice (68%). The biggest concerns about BPTB autograft and hamstring autograft were anterior knee pain (76%) and hamstring weakness (46%), respectively. Most surgeons did not recommend postoperative continuous passive motion (64%) or functional bracing (68%). Most surgeons permitted return to sport without restrictions at 6 to 8 months following surgery (82%). Surgeons who routinely used functional bracing after ACL surgery more frequently used hamstring autograft than those who used BPTB autograft (P = .04).
This article successfully describes current management of ACL injuries among MLS team orthopaedic surgeons. The preference for single-bundle BPTB autograft is similar to published data in the National Football League and National Basketball Association.
对于精英足球运动员前交叉韧带（ACL）损伤的治疗和康复程序存在争议。争议点包括手术时机、技术、移植物选择、康复以及重返运动的标准和时间。
确定美国职业足球大联盟（MLS）队骨科医生对 ACL 损伤的治疗偏好。
横断面研究；证据水平，4 级。
该调查于 2013 年 1 月在 MLS 队医年度会议上进行。19 个俱乐部（美国 16 个，加拿大 3 个）中至少有 1 名骨科医生代表出席。有多个附属骨科医生的球队将收到额外的调查，要么在会议上完成，要么通过电子邮件返回。对调查回复的各种数据应用描述性统计、Wilcoxon 曼-惠特尼检验（重返赛场参数、跑动和球训练）和 Fisher 精确检验（移植物选择、支具、持续被动运动）。
实现了 100%的调查参与率（22 名代表 19 个 MLS 球队的队医骨科医生）。最常见的技术是单切口、关节镜辅助、单束重建（91%）。关于股骨隧道钻取，医生意见不一（50%经胫骨，46%辅助内侧）。自体移植物骨-髌腱-骨（BPTB）是最常见的首选移植物（68%）。BPTB 自体移植物和腘绳肌自体移植物最令人担忧的问题分别是前膝疼痛（76%）和腘绳肌无力（46%）。大多数医生不建议术后使用持续被动运动（64%）或功能性支具（68%）。大多数医生允许在手术后 6 至 8 个月内不受限制地重返运动（82%）。常规在 ACL 手术后使用功能性支具的医生比使用 BPTB 自体移植物的医生更常使用腘绳肌自体移植物（P =.04）。
本文成功描述了 MLS 队医对 ACL 损伤的当前治疗方法。对单束 BPTB 自体移植物的偏好与国家橄榄球联盟和国家篮球协会的已发表数据相似。
