An international survey on anterior cruciate ligament reconstruction practices.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Surgeon preferences in ACL reconstruction differ considerably worldwide. Common practice is not always supported by evidence-based publications.
Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel. ofirchik@yahoo.com
Ofir
O
Chechik
Eyal
E
Amar
Morsi
M
Khashan
Ran
R
Lador
Gil
G
Eyal
Aviram
A
Gold
D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D007718:Knee Injuries / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D014184:Transplantation, Homologous