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



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.


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.


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.


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


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.



Esther Eshkol is thanked for editorial assistance.


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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

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