Orthopaedic Surgery, Stanford University, Redwood City, California, USA
Orthopaedic Surgery, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
J ISAKOS. 2021 Nov;6(6):322-328. doi: 10.1136/jisakos-2020-000567. Epub 2021 Jul 16.
OBJECTIVES: The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG). METHODS: A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more. RESULTS: The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%). CONCLUSION: We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR. LEVEL OF EVIDENCE: Level V, Expert Opinion.
目的：本调查的主要目的是通过前交叉韧带（ACL）研究组（SG）成员报告的情况，评估当前全球前交叉韧带重建（ACLR）的趋势。
方法：创建了一项调查，并分发给 ACL SG 的成员，该调查包含 87 个问题和 16 个与 ACLR 相关的类别，包括成员人口统计学、术前管理、主要 ACLR 技术和移植物选择、同时进行的程序和生物增强的使用、术后康复等。
结果：ACL SG 的 140 名成员完成了调查。50%的成员来自欧洲，29%来自美国，15%来自亚太地区，其余 6%来自拉丁美洲、中东、新西兰和非洲。大多数（92%）认为对于高水平运动员来说，ACL 撕裂的非手术治疗没有作用；相反，大多数人认为非手术治疗对于低影响运动员有作用（92%）。对于初次 ACLR，最常见的是单束（90%）技术和腘绳肌腱自体移植物（53%）。受访者的隧道位置不同。61%的人不使用同种异体移植物进行初次 ACLR。50%的受访者在股骨上使用皮质悬吊固定，胫骨上的反应则各不相同。大多数（79%）在初次 ACLR 中不使用生物制剂，而 83%的人认为在初次 ACLR 中有选择地使用关节外增强是有作用的。50%的人更喜欢用于翻修 ACLR 的骨-腱-骨自体移植物，而关节外增强在初次 ACLR 中更常用（13%总是，26%经常），而在初次 ACLR 中不常用（0%总是，15%经常）。大多数（53%）在初次 ACLR 后使用支具。初次 ACLR 后恢复运动时间最短的最常见反应是 6-8 个月（44%）和 8-12 个月（41%）。
结论：我们展示了 ACL SG 对 ACL 损伤管理的想法和偏好。本调查将通过提供全球范围内 ACLR 手术趋势的见解，帮助促进对 ACLR 的持续讨论。
证据水平：五级，专家意见。
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