Faculty of Health Sciences, Western University, London, ON, Canada.
Fowler Kennedy Sport Medicine Clinic, London, ON, Canada.
Knee Surg Sports Traumatol Arthrosc. 2021 Dec;29(12):4286-4295. doi: 10.1007/s00167-021-06550-7. Epub 2021 Apr 19.
The priorities of patients should be shared by those treating them. Patients and surgeons are likely to have different priorities surrounding anterior cruciate ligament reconstruction (ACLR), with implications for shared decision-making and patient education. The optimal surgical approach for ACLR is constantly evolving, and the magnitude of treatment effect necessary for evidence to change surgical practice is unknown. The aim of this study was to determine (1) the priorities of surgeons and patients when making decisions regarding ACLR and (2) the magnitude of reduction in ACLR graft failure risk that orthopaedic surgeons require before changing practice.
This study followed a cross-sectional survey design. Three distinct electronic surveys were administered to pre-operative ACLR patients, post-operative ACLR patients, and orthopaedic surgeons. Patients and surgeons were asked about the importance of various outcomes and considerations pertaining to ACLR. Surgeons were asked scenario-based questions regarding changing practice for ACLR based on new research.
Surgeons were more likely to prioritize outcomes related to the surgical knee itself, whereas patients were more likely to prioritize outcomes related to their daily lifestyle and activities. Knee instability and risk of re-injury were unanimous top priorities among all three groups. A mean relative risk reduction in ACLR graft failure of about 50% was required by orthopaedic surgeons to change practice regardless of the type of change, or patient risk profile.
There are discrepancies between the priorities of surgeons and patients, and orthopaedic surgeons appear resistant to changing practice for ACLR.
IV.
治疗患者的人应与患者共同分担治疗重点。患者和外科医生在围绕前交叉韧带重建（ACLR）的问题上可能存在不同的侧重点，这对共同决策和患者教育具有重要意义。ACL 重建的最佳手术方法在不断发展，而改变手术实践所需的治疗效果的幅度大小对于证据改变手术实践尚不清楚。本研究的目的是确定（1）外科医生和患者在 ACLR 决策中的重点，以及（2）骨科医生在改变实践之前需要 ACLR 移植物失败风险降低的幅度大小。
本研究采用横断面调查设计。针对术前 ACLR 患者、术后 ACLR 患者和骨科医生分别进行了三项不同的电子调查。患者和外科医生被问及与 ACLR 相关的各种结果和考虑因素的重要性。外科医生被问及基于新研究改变 ACLR 实践的基于场景的问题。
外科医生更倾向于重视与手术膝关节本身相关的结果，而患者则更倾向于重视与日常生活和活动相关的结果。膝关节不稳定和再次受伤的风险是所有三组人群的共同首要重点。无论改变的类型或患者的风险特征如何，骨科医生都需要 ACLR 移植物失败的平均相对风险降低约 50%，才能改变实践。
外科医生和患者的重点存在差异，而骨科医生似乎不愿意改变 ACLR 的实践。
IV。
