Abstract
Purpose
The aim of this study was to report Italian orthopaedic surgeons’ management of choice for ACL reconstruction and rehabilitation, and to compare surgical applications and rehabilitation approaches of Italian surgeons to the current approaches of “ACL Study Group”. A secondary purpose was to compare the preferences of subgroup based on graft choice, surgical techniques and experience.
Methods
A web-based survey was developed to investigate the attitudes of members of a national association specialized in sports traumatology and knee surgery (SIGASCOT) regarding surgical techniques, routine post-operative applications, rehabilitation approaches and starting time of specific activities and exercises following ACL reconstruction.
Results
The response rate was 17 % (131 questionnaires). The most popular graft type was hamstring tendon (81 % in male patients, and 91 % in female patients). The rate of continuous passive motion use was 55 %. Half surgeons routinely used a brace (49 %), usually a hinged brace. In total, 33.0 % of surgeons allowed patients to load the operated knee as much as tolerated within the first 2 weeks. Fifty-nine per cent of surgeons did not limit full flexion within the first 2 weeks. Most surgeons advise to wait until 4 months or more (97 %) for return to sports not requiring contact, and 6 months or more for full-contact sport (86 %).
Conclusions
This survey demonstrates clear trends in the practice of ACL reconstruction and rehabilitation in Italy. The data obtained from the SIGASCOT members revealed a more conservative approach when compared to the current approaches of “ACL Study Group”.
Level of evidence
Cross-sectional survey, Level III.
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Acknowledgments
We would like to thank to all orthopaedists who participated in our questionnaire.
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Appendix: Study questionnaire with summarized results
Appendix: Study questionnaire with summarized results
(1) How many ACL reconstructions are you performing per year? | |||
<25 | 25–50 | 50–100 | More than 100 |
37.2 % | 28.7 % | 22.5 % | 11.6 % |
(2) What type of graft you use preferably in the reconstruction of the anterior cruciate ligament in male patients? | ||||
Patellar tendon | Hamstring (semitendinosus/gracilis) tendons | Quadriceps tendon | Allograft | Artificial ligament |
16.5 % | 81.1 % | 0 % | 1.6 % | 0.8 % |
(3) What type of graft you use preferably in the reconstruction of the anterior cruciate ligament in female patients? | ||||
Patellar tendon | Hamstring (semitendinosus/gracilis) tendons | Quadriceps tendon | Allograft | Artificial ligament |
6.4 % | 91.2 % | 0 % | 1.6 % | 0.8 % |
(4) What type of graft you use preferably in the reconstruction of the anterior cruciate ligament in professional athletes? | ||||
Patellar tendon | Hamstring (semitendinosus/gracilis) tendons | Quadriceps tendon | Allograft | Artificial ligament |
49.6 % | 44.8 % | 0 % | 4.8 % | 0.8 % |
(5) Do you use the same graft regardless of the sport practiced? | Yes | No |
56.0 % | 44.0 % |
(6) What type of surgery you use preferably? | Double bundle | Single bundle |
7.0 % | 93.0 % |
(7) What type of surgery you use preferably to perform the femoral tunnel? | Transtibial | Anteromedial portal | Out-in technique |
60.5 % | 29.0 % | 10.5 % |
(8) What type of femoral fixation you use preferably? | ||||
Compression | Expansion | Cortical suspension | Cortico-cancellous suspension | Others |
11.2 % | 24.0 % | 51.2 % | 4.0 % | 9.6 % |
(9) Do you routinely brace your patients post-operatively? | Yes | No |
49.19 % | 50.8 % |
If yes. What type of brace? | Mouldable | Hinged | Rigid | |
5.5 % | 64.4 % | 30.1 % | ||
If yes. How long? | ≤2 weeks | 2–4 weeks | 4–6 weeks | ≥6 weeks |
19.2 % | 69.8 % | 11.0 % | 0.0 % |
(10) What is the duration of loading post-operatively? | ≤2 weeks | 2–4 weeks | 4–6 weeks | ≥6 weeks |
As much as it is tolerated | 33.0 % | 44.4 % | 20.9 % | 1.7 % |
Limited loading | 72.2 % | 26.9 % | 0.9 % | 0.0 % |
(11) Do your patients routinely use continuous passive motion post-operatively? | Yes | No |
55.12 % | 44.88 % |
(12) Do you limit full flexion at the knee? | ≤2 weeks | 2–4 weeks | 4–6 weeks | ≥6 weeks |
No | 58.6 % | 9.9 % | 22.5 % | 9.0 % |
0°–90° | 61.9 % | 30.5 % | 7.6 % | 0.0 % |
0°–45° | 87.8 % | 12.2 % | 0.0 % | 0.0 % |
0°–20° | 97.6 % | 2.4 % | 0.0 % | 0.0 % |
(13) Which of the below do you prefer following ACL reconstruction? | |
Home exercise programmes | Professional rehabilitation programmes |
10.2 % | 89.8 % |
(14) Do you have standard rehabilitation programme? | Yes | No |
84.3 % | 15.7 % |
(15) When do you start below specific activities/exercises? | ||||
≤2 weeks | 2–4 weeks | 4–6 weeks | ≥6 weeks | |
Proprioceptive exercise | 14.4 % | 21.6 % | 45.6 % | 18.4 % |
Exercise bicycle | 2.4 % | 30.4 % | 50.4 % | 16.8 % |
≤4 weeks | 4–6 weeks | 6–8 weeks | ≥8 weeks | |
Running in treadmill | 1.6 % | 9.6 % | 37.60 % | 51.20 % |
Running in outside | 0.8 % | 2.5 % | 12.3 % | 84.4 % |
≤6 weeks | 6–12 weeks | 3–6 months | ≥6 months | |
Strengthening open kinetic chain quadriceps between 90° and 40° | 12.0 % | 44.8 % | 34.4 % | 8.8 % |
≤2 months | 2–4 months | ≥4 months | never | |
Isokinetic exercises for strengthening | 29.8 % | 44.4 % | 21.8 % | 4.0 % |
≤2 months | 2–4 months | 4–6 months | 6–8 months | 8–10 months | 10–12 months | >12 months | |
Sport-specific rehabilitation | 3.2 % | 29.8 % | 56.5 % | 9.7 % | 0.8 % | 0.0 % | 0.0 % |
Skills on sports not requiring contact | 0.8 % | 21.8 % | 64.5 % | 12.1 % | 0.8 % | 0.0 % | 0.0 % |
Skills on sports requiring contact | 0.8 % | 1.6 % | 41.6 % | 48.0 % | 6.4 % | 0.8 % | 0.8 % |
Return to sports not requiring contact | 0.0 % | 3.3 % | 44.7 % | 43.9 % | 7.3 % | 0.8 % | 0.0 % |
Return to sports requiring contact | 0.0 % | 0.8 % | 13.6 % | 58.4 % | 20.8 % | 6.4 % | 0.0 % |
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Vascellari, A., Grassi, A., Combi, A. et al. Web-based survey results: surgeon practice patterns in Italy regarding anterior cruciate ligament reconstruction and rehabilitation. Knee Surg Sports Traumatol Arthrosc 25, 2520–2527 (2017). https://doi.org/10.1007/s00167-016-4007-3
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DOI: https://doi.org/10.1007/s00167-016-4007-3