Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2020 Nov;28(11):3613-3621. doi: 10.1007/s00167-020-06011-7. Epub 2020 Apr 23.
To assess current surgical preferences and practice patterns regarding primary anterior cruciate ligament (ACL) repair among European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members.
A web-based survey was designed, including questions regarding indications for primary repair, outcomes of primary repair, and rehabilitation protocols. An invitation for study participation was sent by email to all ESSKA e-mail contacts. Descriptive statistics were performed.
A total of 169 surgeons responded to the survey (7% response rate of active members). Lack of supporting scientific evidence is the main reason for not using repair as a surgical treatment (63%). Most important indications were proximal avulsion tears (84%), younger age (49%), and older age (34%). Among those currently utilizing repair as a treatment option, transosseous tunnel fixation repair (34%) and repair with internal brace using transosseous tunnel fixation (32%) were the most preferred techniques. Eleven percent indicated dynamic intraligamentary stabilization as their preferred technique. A similar rate of progression for rehabilitation for repair and reconstruction techniques was noted among respondents.
This practice survey shows that the majority of surgeons indicated the main reason for not incorporating primary repair in their current practices was a lack of supporting scientific evidence. Among those holding favourable attitudes and beliefs, most surgeons indicated patients with proximal tears, younger-aged, and older-aged patients might be eligible for repair. Prospective studies with higher levels of evidence are warranted to establish guidelines for repair, including indications, optimal surgical technique, and rehabilitation protocols.
V (expert opinion).
评估欧洲运动创伤学、膝关节外科和关节镜学会（ESSKA）成员目前在初次前交叉韧带（ACL）修复方面的手术偏好和实践模式。
设计了一项基于网络的调查，其中包括有关初次修复的适应证、初次修复的结果和康复方案的问题。通过电子邮件向所有 ESSKA 电子邮件联系人发送了研究参与邀请。进行了描述性统计。
共有 169 名外科医生对调查做出了回应（活跃成员的 7%应答率）。缺乏支持性的科学证据是不将修复作为手术治疗的主要原因（63%）。最重要的适应证是近端撕脱伤（84%）、年龄较小（49%）和年龄较大（34%）。在那些目前将修复作为治疗选择的医生中，经骨隧道固定修复（34%）和使用经骨隧道固定的内部支撑修复（32%）是最受欢迎的技术。11%的医生表示动态韧带内稳定是他们首选的技术。修复和重建技术的康复进展速度在受访者中相似。
这项实践调查表明，大多数外科医生表示，他们目前不将初次修复纳入实践的主要原因是缺乏支持性的科学证据。在那些持有利态度和信念的医生中，大多数医生表示，近端撕裂、年轻和年老的患者可能有资格接受修复。需要进行具有更高证据水平的前瞻性研究，以制定修复的指南，包括适应证、最佳手术技术和康复方案。
V（专家意见）。
