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Same knee, different goals: patients and surgeons have different priorities related to ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The priorities of patients should be shared by those treating them. Patients and surgeons are likely to have different priorities surrounding anterior cruciate ligament reconstruction (ACLR), with implications for shared decision-making and patient education. The optimal surgical approach for ACLR is constantly evolving, and the magnitude of treatment effect necessary for evidence to change surgical practice is unknown. The aim of this study was to determine (1) the priorities of surgeons and patients when making decisions regarding ACLR and (2) the magnitude of reduction in ACLR graft failure risk that orthopaedic surgeons require before changing practice.

Methods

This study followed a cross-sectional survey design. Three distinct electronic surveys were administered to pre-operative ACLR patients, post-operative ACLR patients, and orthopaedic surgeons. Patients and surgeons were asked about the importance of various outcomes and considerations pertaining to ACLR. Surgeons were asked scenario-based questions regarding changing practice for ACLR based on new research.

Results

Surgeons were more likely to prioritize outcomes related to the surgical knee itself, whereas patients were more likely to prioritize outcomes related to their daily lifestyle and activities. Knee instability and risk of re-injury were unanimous top priorities among all three groups. A mean relative risk reduction in ACLR graft failure of about 50% was required by orthopaedic surgeons to change practice regardless of the type of change, or patient risk profile.

Conclusion

There are discrepancies between the priorities of surgeons and patients, and orthopaedic surgeons appear resistant to changing practice for ACLR.

Level of evidence

IV.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ACLSG:

ACL Study Group

RD:

Risk difference

RRR:

Relative risk reduction

CI:

Confidence interval

RCTs:

Randomized clinical trials

OA:

Osteoarthritis

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Acknowledgements

The authors would like to thank the ACL Study Group for participating in this study. The authors would also like to acknowledge Dr. Robert Litchfield, Dr. Kevin Willits and Dr. Ryan Degen for allowing their patients to be recruited for this study.

Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, Western University, London, ON, Canada

    Hana Marmura, Dianne M. Bryant, Trevor B. Birmingham, Anita Kothari & Alan M. J. Getgood

  2. Fowler Kennedy Sport Medicine Clinic, London, ON, Canada

    Hana Marmura, Dianne M. Bryant & Alan M. J. Getgood

  3. Bone and Joint Institute, Western University, London, ON, Canada

    Hana Marmura, Dianne M. Bryant, Trevor B. Birmingham & Alan M. J. Getgood

  4. Lawson Research, London Health Sciences Centre, London, ON, Canada

    Hana Marmura, Dianne M. Bryant & Alan M. J. Getgood

  5. Department of Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada

    Dianne M. Bryant & Alan M. J. Getgood

  6. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Dianne M. Bryant

  7. Wolf Orthopaedic Biomechanics Lab, Fowler Kennedy Sport Medicine Clinic, London, ON, Canada

    Trevor B. Birmingham

  8. Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA

    Kurt P. Spindler

  9. Department of Orthopaedics, The Ohio State University, Ohio, USA

    Christopher C. Kaeding

  10. Department of Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK

    Tim Spalding

Authors
  1. Hana Marmura
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  2. Dianne M. Bryant
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  3. Trevor B. Birmingham
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  4. Anita Kothari
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  5. Kurt P. Spindler
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  6. Christopher C. Kaeding
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  7. Tim Spalding
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  8. Alan M. J. Getgood
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Contributions

HM helped with study conception and design, completed data collection, completed statistical analysis, helped with interpretation of the data and drafted the manuscript. DMB helped with study conception and design, statistical analysis, interpretation of the data and drafting the manuscript. TBB helped with study conception and design, interpretation of the data and drafting the manuscript. AK helped with study conception and design, interpretation of the data and drafting the manuscript. KPS helped with interpretation of the data and critically revised the manuscript. CCK helped with data collection, interpretation of the data and critically revised the manuscript. TS helped with data collection, interpretation of the data and critically revised the manuscript. AMJG helped with study conception and design, data collection, interpretation of the data and drafting the manuscript.

Corresponding author

Correspondence to Alan M. J. Getgood.

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Conflict of interest

H.M., D.M.B, T.B.B. and K.T. declare that they have no competing interests. K.P.S. has received consulting fees from the National Football League, Service Excellence, Mitek, Flexion, Samumed and Novopeds; research funding from Smith & Nephew Endoscopy, DonJoy Orthopedics and NIH/NIAMS; and hospitality payments from DePuy and Biosense Webster. C.C.K. was the past president of the ACL Study Group and has received research funding from DJO and Zimmer Biomet, consulting fees from Zimmer Biomet, education payments from CDC Medical, and compensation for services other than consulting from Arthrex. T.S. is the President of the ACL Study Group and has received speaking fees from Conmed, Smith & Nephew, and JRF Ortho, and royalties from Conmed. A.M.J.G. is the Program Chair of the ACL Study Group and has received royalties from Smith & Nephew and Graymont Inc, research funding from Smith & Nephew and Ossur, and consulting fees from Smith & Nephew, Ossur, and Olympus.

Ethical approval

This study was grant ethics approval by the Western University Health Science Research Ethics Board (Ref #: 114977).

Informed consent

Informed consent was obtained from all participants.

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Marmura, H., Bryant, D.M., Birmingham, T.B. et al. Same knee, different goals: patients and surgeons have different priorities related to ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 4286–4295 (2021). https://doi.org/10.1007/s00167-021-06550-7

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  • DOI: https://doi.org/10.1007/s00167-021-06550-7

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