Advertisement

International Orthopaedics

, Volume 37, Issue 2, pp 201–206 | Cite as

An international survey on anterior cruciate ligament reconstruction practices

  • Ofir Chechik
  • Eyal Amar
  • Morsi Khashan
  • Ran Lador
  • Gil Eyal
  • Aviram Gold
Original Paper

Abstract

Purpose

Bone-patellar-tendon-bone (BPTB) autografting fixed with metal interference screws (IS) is the gold standard for anterior cruciate ligament (ACL) reconstruction. Advances in surgical technology provide a wide choice of grafts, fixation devices and surgical approaches.

Methods

Two-hundred and sixty-one orthopedic surgeons of ten subspecialties from 57 countries were surveyed on their choice of graft and fixation device, the number of reconstructed bundles, and arthroscopic portal. Their preferences were analyzed according to country of origin, field of expertise and seniority, and compared to current publications.

Results

Hamstring autografting was the most popular choice (63 %), then BPTB (26 %) and allograft (11 %). The anteromedial portal was preferred over the traditional transtibial portal (68 % versus 31 %). Two-thirds reported routinely performing a single-bundle graft reconstruction, compared to one-third who used the double-bundle technique. The Endo-button was the most common graft fixation method (40 %), followed by the bioabsorbable IS (34 %), metallic IS (12 %), rigidfix (10 %) and others (4 %). The preferences of hamstring tendon grafting and the anteromedial portal are not supported in the literature. Responses from North American and European surgeons were different from all the others.

Conclusions

Surgeon preferences in ACL reconstruction differ considerably worldwide. Common practice is not always supported by evidence-based publications.

Keywords

Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Femoral Tunnel Pivot Shift Anterior Knee Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Esther Eshkol is thanked for editorial assistance.

References

  1. 1.
    Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2010) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligamentreconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1013–1037PubMedCrossRefGoogle Scholar
  2. 2.
    Araki D, Kuroda R, Kubo S, Fujita N, Tei K, Nishimoto K, Hoshino Y, Matsushita T, Matsumoto T, Nagamune K, Kurosaka M (2011) A prospective randomised study of anatomical single-bundle versus double-bundle anteriorcruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system. Int Orthop 35(3):439–446PubMedCrossRefGoogle Scholar
  3. 3.
    Baer GS, Harner CD (2007) Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction. Clin Sports Med 26(4):661–681PubMedCrossRefGoogle Scholar
  4. 4.
    Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction:an anatomic and biomechanicalevaluation of surgical technique. Arthroscopy 27(3):380–390PubMedCrossRefGoogle Scholar
  5. 5.
    Biau DJ, Katsahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Röpke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478PubMedCrossRefGoogle Scholar
  6. 6.
    Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27(11):1511–1522PubMedCrossRefGoogle Scholar
  7. 7.
    Chang CB, Choi JY, Koh IJ, Lee KJ, Lee KH, Kim TK (2011) Comparisons of femoral tunnel position and length in anterior cruciate ligament reconstruction: modified transtibial versus anteromedial portal techniques. Arthroscopy 27(10):1389–1394PubMedCrossRefGoogle Scholar
  8. 8.
    Chen NC, Brand JC Jr, Jr Brown CH (2007) Biomechanics of intratunnel anterior cruciate ligament graft fixation. Clin Sports Med 26(4):695–714PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen SB, Sekiya JK (2007) Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med 26:597–605PubMedCrossRefGoogle Scholar
  10. 10.
    Colvin A, Sharma C, Parides M, Glashow J (2011) What is the best femoral fixation of hamstring autografts in anterior cruciate ligament reconstruction?: a meta-analysis. Clin Orthop Relat Res 469(4):1075–1081PubMedCrossRefGoogle Scholar
  11. 11.
    Delay BS, Smolinski RJ, Wind WM, Bowman DS (2001) Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine. Am J Knee Surg 14(2):85–91PubMedGoogle Scholar
  12. 12.
    Duquin TR, Wind WM, Fineberg MS, Smolinski RJ, Buyea CM (2009) Current trends in anterior cruciate ligament reconstruction. J Knee Surg 22(1):7–12PubMedCrossRefGoogle Scholar
  13. 13.
    Elliott MJ, Kurtz CA (2007) Peripheral versus aperture fixation for anterior cruciate ligament reconstruction. Clin Sports Med 26(4):683–693PubMedCrossRefGoogle Scholar
  14. 14.
    Emond CE, Woelber EB, Kurd SK, Ciccotti MG, Cohen SB (2011) A comparison of the results of anterior cruciate ligament reconstruction using bioabsorbable versus metal interference screws: a meta-analysis. J Bone Joint Surg Am 93(6):572–580PubMedCrossRefGoogle Scholar
  15. 15.
    Gaweda K, Walawski J, Wegłowski R, Krzyzanowski W (2009) Comparison of bioabsorbable interference screws and posts for distal fixation in anteriorcruciate ligament reconstruction. Int Orthop 33(1):123–127PubMedCrossRefGoogle Scholar
  16. 16.
    Krych AJ, Jackson JD, Hoskin TL, Dahm DL (2008) A meta-analysis of patellar tendon autograft versus patellar tendon allograft in anterior cruciate ligament reconstruction. Arthroscopy 24(3):292–298PubMedCrossRefGoogle Scholar
  17. 17.
    Kuhn JE, Dunn WR, Spindler KP (2005) Evidence-based medicine for orthopedic surgeons. J Knee Surg 18(1):57–63PubMedGoogle Scholar
  18. 18.
    Lawhorn KW, Howell SM (2007) Principles for using hamstring tendons for anterior cruciate ligament reconstruction. Clin Sports Med 26(4):567–585PubMedCrossRefGoogle Scholar
  19. 19.
    Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25(1):95–101PubMedCrossRefGoogle Scholar
  20. 20.
    Reinhardt KR, Hetsroni I, Marx RG (2010) Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 41(2):249–262PubMedCrossRefGoogle Scholar
  21. 21.
    Romanini E, D'Angelo F, De Masi S, Adriani E, Magaletti M, Lacorte E, Laricchiuta P, Sagliocca L, Morciano C, Mele A (2010) Graft selection in arthroscopic anterior cruciate ligament reconstruction. J Orthop Traumatol 11(4):211–219PubMedCrossRefGoogle Scholar
  22. 22.
    Sadoghi P, Müller PE, Jansson V, van Griensven M, Kröpfl A, Fischmeister MF (2011) Reconstruction of the anterior cruciate ligament: a clinical comparison of bone-patellar tendon-bone single bundle versus semitendinosus and gracilis double bundle technique. Int Orthop 35(1):127–133PubMedCrossRefGoogle Scholar
  23. 23.
    Schoderbek RJ Jr, Treme GP, Miller MD (2007) Bone-patella tendon-bone autograft anterior cruciate ligament reconstruction. Clin Sports Med 26(4):525–547PubMedCrossRefGoogle Scholar
  24. 24.
    Suk M, Hanson B, Helfet DL (2010) Evidence-based orthopedic surgery: is it possible? Orthop Clin North Am 41(2):139–143PubMedCrossRefGoogle Scholar
  25. 25.
    van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) "Anatomic" anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(9 Suppl):S2–S12PubMedGoogle Scholar
  26. 26.
    Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(9 Suppl):S21–S34PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ofir Chechik
    • 1
  • Eyal Amar
    • 1
  • Morsi Khashan
    • 1
  • Ran Lador
    • 1
  • Gil Eyal
    • 2
  • Aviram Gold
    • 1
  1. 1.Department of Orthopedic SurgeryTel Aviv Sourasky Medical CenterTel-AvivIsrael
  2. 2.Department of Orthopedic SurgeryRabin Medical CenterPetah TikvahIsrael

Personalised recommendations