Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A..
Kerlan Jobe Institute, Los Angeles, California, U.S.A.
Arthroscopy. 2021 May;37(5):1559-1566. doi: 10.1016/j.arthro.2021.01.042. Epub 2021 Feb 1.
The purpose of this study was to define the anterior cruciate ligament (ACL) reconstruction (ACLR) graft preference of surgeons and to explore factors associated with their predilection.
A 15-question survey regarding ACLR graft preference in various situations was completed by 514 American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America surgeons. Surgeon and practice demographics, along with various patient factors, were evaluated with bivariate and multivariable models for association with surgeon preference. Surgeons were also queried about their preference for their own ACLR. For surgeons who personally sustained an ACL, an additional 6 questions inquired about their experience.
Surgeons reported the 5 most important factors in patient graft choice, in order: patient age, graft failure in literature and practice, pivot sport, and patient preference. Autograft patellar and quadriceps tendon were strongly preferred for younger, pivoting athletes (P < .001), among those with fellowship training (47% vs 33%, P = .006), in academic practices (52% vs 44%, P = .003), and in more sports medicine-specific practices, with a higher number of ACLRs performed per year (P < .001). Northeast, Southeast, Midwest, and Southwest surgeons had lower hamstring autograft preference (P < .001). Non-fellowship-trained surgeons preferred hamstring autograft (P = .010). Allograft was preferred for older patients (P < .001). Nonsignificant predictors included highest level of athlete for whom an ACLR had been performed, level of athlete serving as team physician, and years in practice. No factors were associated with surgeon preference for their own ACLR despite deeming these factors important for patients. ACL tears were reported by 13% of respondents, with 86% stating it influenced their decision to enter orthopaedics.
Patient age was the most important factor in graft choice, with patellar and quadriceps tendon autograft the preferred graft for ACLR for younger, pivoting athletes. Fellowship training and practice demographics were also correlated with graft choice for patients.
Graft preference for ACLR varies among surgeons and is associated with surgeon experience and patient characteristics, including patient age, type of sport, and patient preference.
本研究旨在确定外科医生对前交叉韧带（ACL）重建（ACLR）移植物的偏好，并探讨与他们的倾向相关的因素。
514 名美国矫形外科运动医学学会和北美关节镜协会的外科医生完成了一份关于 ACLR 移植物在各种情况下偏好的 15 个问题的调查。使用双变量和多变量模型评估外科医生和实践特征以及各种患者因素与外科医生偏好的关联。还询问了外科医生对自己 ACLR 的偏好。对于个人遭受 ACL 损伤的外科医生，另外 6 个问题询问了他们的经验。
外科医生报告了患者移植物选择的 5 个最重要因素，按重要性顺序依次为：患者年龄、文献和实践中的移植物失败、枢轴运动和患者偏好。对于年轻的、枢轴运动的运动员，自体移植物髌腱和四头肌腱被强烈首选（P<.001），在接受 fellowship 培训的外科医生中（47%比 33%，P=.006），在学术实践中（52%比 44%，P=.003），以及在更专注于运动医学的实践中，每年进行的 ACLR 数量更多（P<.001）。东北、东南、中西部和西南部的外科医生对腘绳肌自体移植物的偏好较低（P<.001）。非 fellowship 培训的外科医生更喜欢腘绳肌自体移植物（P=.010）。对于老年患者，同种异体移植物更受青睐（P<.001）。虽然外科医生认为这些因素对患者很重要，但没有因素与他们对自己 ACLR 的偏好相关。13%的受访者报告有 ACL 撕裂，86%的人表示这影响了他们选择进入矫形外科的决定。
患者年龄是移植物选择的最重要因素，对于年轻的、枢轴运动的运动员，髌腱和四头肌腱自体移植物是 ACLR 的首选移植物。 fellowship 培训和实践特征也与患者的移植物选择相关。
ACL 重建的移植物偏好因外科医生而异，与外科医生的经验和患者特征相关，包括患者年龄、运动类型和患者偏好。
