title: Continental variations in preoperative and postoperative management of patients with anterior cruciate ligament repair.
abstract: OBJECTIVE
  Surgeon decision making for non-operative anterior cruciate ligament (ACL) treatment and postoperative rehabilitation is influenced by a myriad of factors. The aim of this study was to investigate intercontinental differences in surgeon decision making for care of the ACL deficient patient. The authors hypothesized that significant variation in clinical decision of ACL deficient patients existed among surgeons in different continents.
  
  
  METHODS
  This study involved a survey design, which met the checklist for reporting results of internet e-surveys (CHERRIES) guidelines. The survey was administered to orthopedic surgeons in 15 countries and involved standardized follow up and design. Questions related to non-operative care management and postoperative/rehabilitative management were provided to each respondent. Statistical analyses included multivariate comparisons among continents and regression findings for likelihood of targeting longer term non-operative treatment.
  
  
  RESULTS
  Over six hundred (634) surgeons completed the survey, representing six continents. Continental variations were found in non-operative surgical decision making and postoperative/rehabilitative management. Significant differences were noted in nearly all clinical decision making categories.
  
  
  CONCLUSIONS
  Variations do exist across continents in the non-operative and postoperative/rehabilitative management of patients with an ACL tear. Continental variations and disparate emphases such as activity level, age during injury, and bracing influenced treatment decision making, which could lead to variations in outcomes, costs, and appropriate care.
authors.affiliation: Centers of Excellence in Surgical Outcomes, Department of Surgery, Duke University, Durham, NC, USA. chad.cook@duke.edu
authors.forename: C
authors.initials: C
authors.lastname: Cook
authors.forename: L
authors.initials: L
authors.lastname: Nguyen
authors.forename: E
authors.initials: E
authors.lastname: Hegedus
authors.forename: A
authors.initials: A
authors.lastname: Sandago
authors.forename: R
authors.initials: R
authors.lastname: Pietrobon
authors.forename: D
authors.initials: D
authors.lastname: Constantinou
authors.forename: B
authors.initials: B
authors.lastname: Chuckpaiwong
authors.forename: J
authors.initials: J
authors.lastname: Sandhu
authors.forename: C T
authors.initials: CT
authors.lastname: Moorman
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D019637:Orthopedic Procedures / Q000534:rehabilitation* / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000534:rehabilitation* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000534:rehabilitation* / Q000706:statistics & numerical data; D012046:Rehabilitation / Q000458:organization & administration / Q000706:statistics & numerical data; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery