Anterior cruciate ligament reconstruction practice patterns by NFL and NCAA football team physicians.
OBJECTIVE
This study aimed to determine practice patterns for National Football League (NFL) and National Collegiate Athletic Association (NCAA) Division I football team orthopaedic surgeons regarding management of anterior cruciate ligament (ACL) tears in elite, young, and middle-aged recreational athletes.


METHODS
Two hundred sixty-seven NFL and NCAA Division I team orthopaedic surgeons were surveyed through an online survey. A 9-question survey assessed surgeon experience, graft choice, femoral tunnel drilling access, number of graft bundles, and rehabilitation after ACL reconstruction.


RESULTS
One hundred thirty-seven team orthopaedic surgeons (51%) responded (mean experience 16.75 ± 8.7 years). Surgeons performed 82 ± 50 ACL reconstructions in 2012. One hundred eighteen surgeons (86%) would use bone-patellar tendon-bone (BPTB) autografts to treat their starting running backs. Ninety (67%) surgeons drill the femoral tunnel through an accessory anteromedial portal (26% through a transtibial portal). Only 1 surgeon prefers a double-bundle to a single-bundle reconstruction. Seventy-seven (55.8%) surgeons recommend waiting at least 6 months before return to sport, whereas 17 (12.3%) wait at least 9 months. No surgeon recommends waiting 12 months or more before return to sport. Eighty-eight (64%) surgeons do not recommend a brace for their starting running backs during sport once they return to play.


CONCLUSIONS
BPTB is the most frequently used graft for ACL reconstruction by NFL and NCAA Division I team physicians in their elite-level running backs. Nearly all surgeons always use a single-bundle technique, and most do not recommend a brace on return to sport in running backs. Return to sport most commonly occurs at least 6 months postoperatively, with some surgeons requiring a normal examination and normal return-to-sport testing (single leg hop).
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: berickso.24@gmail.com.
Brandon J
BJ
Erickson
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Joshua D
JD
Harris
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Yale A
YA
Fillingham
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Rachel M
RM
Frank
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Charles A
CA
Bush-Joseph
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Bernard R
BR
Bach
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Brian J
BJ
Cole
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Nikhil N
NN
Verma
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation / Q000706:statistics & numerical data; D005269:Femur / Q000601:surgery; D005538:Football / Q000293:injuries*; D019538:Health Care Surveys; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards* / Q000706:statistics & numerical data; D010027:Osteotomy / Q000379:methods / Q000592:standards; D017847:Patellar Ligament / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000592:standards*; D062707:Return to Work; D013178:Sports Medicine / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States