A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.
Marrelli Hospital, Crotone, Italy.
Knee Surg Sports Traumatol Arthrosc. 2023 Feb;31(2):619-625. doi: 10.1007/s00167-022-07005-3. Epub 2022 Jun 14.
Although the outcomes of ACL reconstruction are generally satisfying, there are several patients who do not regain their pre-injury sporting level and suffer persistent symptoms. Orthopaedic practice has evolved significantly over the last five years to address these drawbacks. The aim of the present survey was to analyze the changes in the approach to ACL reconstruction among a population of young ESSKA surgeons dedicated to ACL surgery.
The survey was uploaded on the ESSKA website and was accessible to members under the age of 45. The ESSKA society has 1035 U45 members involved in multiple aspects of Orthopaedic practice. One hundred and forty questionnaires were returned. Several aspects of ACL surgery were investigated at baseline and 5 years prior. They included general details such as the volume of ACL reconstructions per surgeon per year, the graft choice in cases of low and high demanding patients, the technique for femoral tunnel drilling and the preferred device for femoral fixation. The approach to the management of damage to peripheral structures, as well as meniscal ramp and root tears were also investigated.
Hamstrings and quadrupled semitendinosus were the preferred graft choice in low-demanding patients (92.9%) while quadriceps tendon is gaining popularity in contact sport practitioners (from 4.3 to 10.7%). The percentage of surgeons using femoral screws had decreased from 37.9 to 29.3 while the percentage of those who used buttons increased from 52.9 to 69.3%. Extra-articular procedures (antero-lateral ligament (ALL) or lateral tenodesis have become popular. The percentage of surgeons who perform an additional peripheral reconstruction rose from 28.5 to 71.5%. Of those who perform the meniscal repair more than 50% of patients rose from 14.3 to 27.9%. Similarly, the percentage of surgeons who performed a medial meniscus ramp lesion repair rose from 29.4 to 54.7%. While the percentage of those who choose to perform a transtibial pull-out repair of lateral meniscus root tears significantly rose from 17.9 to 59.3%.
The present survey among under 45 years old ESSKA surgeons yields some notable findings. The new evidence on the impact of injuries on peripheral structures and menisci is stimulating surgeons towards a more anatomic approach if identified at the time of ACL reconstruction. This evidence will probably influence future research and decision-making.
IV.
尽管 ACL 重建的结果通常令人满意，但仍有一些患者无法恢复到受伤前的运动水平，并持续存在症状。过去五年中，矫形实践已经有了显著的发展，以解决这些缺陷。本研究旨在分析致力于 ACL 手术的年轻 ESSKA 外科医生人群中 ACL 重建方法的变化。
该调查已上传到 ESSKA 网站，年龄在 45 岁以下的会员均可访问。ESSKA 协会有 1035 名 U45 成员参与了矫形实践的多个方面。共收回了 140 份问卷。在基线和 5 年前调查了 ACL 手术的几个方面。它们包括一般细节，例如每位外科医生每年进行的 ACL 重建数量、低需求和高需求患者的移植物选择、股骨隧道钻孔技术以及股骨固定的首选器械。还调查了对周围结构损伤、半月板前嵴和根撕裂的管理方法。
在低需求患者中，半腱肌和四头肌腱半腱肌是首选移植物（92.9%），而股四头肌肌腱在接触运动从业者中越来越受欢迎（从 4.3%增加到 10.7%）。使用股骨螺钉的外科医生比例从 37.9%下降到 29.3%，而使用纽扣的外科医生比例从 52.9%增加到 69.3%。关节外手术（前外侧韧带（ALL）或外侧肌腱固定术）变得流行。进行额外的周围重建的外科医生比例从 28.5%上升到 71.5%。对于进行半月板修复的外科医生，超过 50%的患者从 14.3%上升到 27.9%。同样，进行内侧半月板前嵴病变修复的外科医生比例从 29.4%上升到 54.7%。而选择进行外侧半月板根撕裂经胫骨拉出修复的外科医生比例从 17.9%显著上升到 59.3%。
本研究对年龄在 45 岁以下的 ESSKA 外科医生进行了调查，得出了一些值得注意的发现。有关受伤对周围结构和半月板影响的新证据促使外科医生在 ACL 重建时如果发现这些问题，就采用更解剖学的方法。这些证据可能会影响未来的研究和决策。
IV。
