Current trends in anterior cruciate ligament reconstruction.
In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.
Duquin
Thomas R
TR
Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY, USA.
Wind
William M
WM
Fineberg
Marc S
MS
Smolinski
Robert J
RJ
Buyea
Cathy M
CM
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D003625:Data Collection; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods / Q000706:statistics & numerical data; D011182:Postoperative Care