Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury.
OBJECTIVE
The purpose of the study was to quantify the amount of agreement among orthopaedic surgeons regarding the natural history of the anterior cruciate ligament (ACL)-deficient knee, surgery, and rehabilitation, and the treatment of these patients.


METHODS
Physician mail survey.


METHODS
Orthopaedic surgeons were randomly selected from the American Academy of Orthopaedic Surgeons (AAOS) directory. Only individuals who treated or referred ACL-insufficient patients for treatment within the past year were asked to complete the 3-page survey. The survey included 25 questions regarding clinical opinion. Clinical agreement was present when 80% or more of the surgeons agreed on the same response option.


RESULTS
The total number of surgeons who responded to the survey was 397 (response rate, 54.8%) and the number who had treated or referred ACL-insufficient patients in the past year was 261. Among surgeons who completed the questionnaire, the response rates to the individual questions ranged from 92% to 100%. The mean response rate for all questions was 97.4%. The mean age of the surgeons was 48.4 years, and 35.8% considered their practice to be a subspecialty in sports medicine or knee surgery. For 12 questions (48%), there was clinical disagreement among the surgeons. Surgical volume was associated with clinical opinion for 16 of 25 questions (P < or =.05).


CONCLUSIONS
Significant variation is seen in clinical opinion and decision-making regarding ACL injuries among members of the AAOS, particularly regarding whether ACL-deficient patients can participate in all recreational sports activities, that ACL reconstruction reduces the rate of arthrosis, and on the use of braces in the postoperative period. Additionally, surgeons disagreed on the effect of 4 patient characteristics (age over 40, presence of pain, irreparable meniscal tear, injury involving Workers' Compensation) on the decision to perform surgery. Areas of significant clinical uncertainty should be the focus of future research and medical education for orthopaedic surgeons who treat ACL injuries.
Marx
Robert G
RG
Center for Clinical Outcome Research, Hospital for Special Surgery, New York, New York 10021, USA. marxr@hss.edu
Jones
Edward C
EC
Angel
Michael
M
Wickiewicz
Thomas L
TL
Warren
Russell F
RF
D000047:Academies and Institutes; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001291:Attitude of Health Personnel; D003469:Culture; D003625:Data Collection; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000523:psychology / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010820:Physicians / Q000523:psychology*; D011897:Random Allocation; D012494:Sampling Studies; D013178:Sports Medicine; D011795:Surveys and Questionnaires; D014481:United States