title: Treatment of Anterior Cruciate Ligament Injuries by Major League Soccer Team Physicians.
abstract: BACKGROUND
  The treatment and rehabilitation procedures of anterior cruciate ligament (ACL) injuries in elite soccer players are controversial. Points of debate include surgical timing, technique, graft choice, rehabilitation, and return-to-sport criteria and timing.
  
  
  OBJECTIVE
  To identify practice preferences among current Major League Soccer (MLS) team orthopaedic surgeons for ACL injuries.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 4.
  
  
  METHODS
  The survey was administered at the MLS team physician annual meeting in January 2013. At least 1 orthopaedic surgeon representative from each of the 19 clubs (16 from the United States, 3 from Canada) was in attendance. Teams with more than 1 affiliated orthopaedic surgeon were given an additional survey to be completed either at the meeting or returned via e-mail. Descriptive statistics, Wilcoxon Mann-Whitney (return-to-play parameters, running, and ball drills), and Fisher exact tests (graft selection, bracing, continuous passive motion) were applied to the various data sets from the survey responses.
  
  
  RESULTS
  A 100% survey participation rate was achieved (22 team orthopaedic surgeons representing 19 MLS teams). A single-incision, arthroscopically assisted, single-bundle reconstruction was the most common technique (91%). Surgeons were split regarding femoral tunnel drilling (50% transtibial, 46% accessory medial). Autograft bone-patellar tendon-bone (BPTB) was the most common preferred graft choice (68%). The biggest concerns about BPTB autograft and hamstring autograft were anterior knee pain (76%) and hamstring weakness (46%), respectively. Most surgeons did not recommend postoperative continuous passive motion (64%) or functional bracing (68%). Most surgeons permitted return to sport without restrictions at 6 to 8 months following surgery (82%). Surgeons who routinely used functional bracing after ACL surgery more frequently used hamstring autograft than those who used BPTB autograft (P = .04).
  
  
  CONCLUSIONS
  This article successfully describes current management of ACL injuries among MLS team orthopaedic surgeons. The preference for single-bundle BPTB autograft is similar to published data in the National Football League and National Basketball Association.
authors.affiliation: Southwest Michigan Center for Orthopaedics and Sports Medicine, Saint Joseph, Michigan, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Farber
authors.affiliation: Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.affiliation: Westminster, Colorado, USA.
authors.forename: Kaare
authors.initials: K
authors.lastname: Kolstad
authors.affiliation: Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA. ; Institute of Academic Medicine, Houston Methodist Research Institute, Houston, Texas, USA. ; Weill Cornell Medical College, New York, New York, USA.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: McCulloch
keywords: ACL; Major League Soccer; anterior cruciate ligament; football; soccer