172. A SURVEY STUDY REGARDING THE NATURAL HISTORY AND TREATMENT OF ANTERIOR CRUCIATE LIGAMENT INJURY AMONG MEMBERS OF THE CANADIAN ORTHOPAEDIC ASSOCIATION

Abstract

Purpose: To describe the current practices and opinions of members of the Canadian Orthopaedic Association (COA) pertaining to anterior cruciate ligament (ACL) reconstruction.

Method: All orthopaedic surgeon members of the COA residing in Canada were sent an email invitation to take part in a survey via an internet-based survey manager. Expanding on a previously published survey (Marx et al., 2003), the current survey was comprised of 30 questions regarding the natural history of ACL-injured knees, surgical and post-surgical treatment choices, and success of the surgery. Clinical agreement was defined as greater than 80% agreement in choice of response option.

Results: Two hundred and eighty-three surgeons (49.3%) responded to the survey. Responses of the 143 surgeons (50.5%) who indicated they performed ACL reconstruction in the last year are presented. Clinical agreement with respect to surgical technique was demonstrated with respect to only three practices – ipsilateral graft harvest (100%), single incision approach (86.1%), and manual graft tensioning (81.6%). In terms of natural history, the only area of agreement was that hamstring and quadriceps strength affects function in ACL deficient knees (92%). Although less than the clinical agreement threshold, a majority of surgeons indicated their preference for semitendinosis-gracilis autograft (73%), transtibial versus anteromedial portal for establishment of the femoral tunnel (65 versus 29%), notch-plasty (65% only with impingement) and promotion of full weight-bearing and range of motion immediately post-surgery (72.1 and 74.8%, respectively). The most frequent surgeon-reported complications were tunnel widening (9.8%) and graft failure (4.4%). A greater proportion of high-volume surgeons used a manual tensioning device intra-operatively and permitted earlier return to sport (p< 0.05).

Conclusion: In the rapidly evolving area of ACL reconstruction, no recent survey of practices and opinions of orthopaedic surgeons has been published. The current survey is more extensive than others conducted to date and attempts to involve all practicing orthopaedic surgeons in Canada. In addition to providing information from a Canadian perspective, such an undertaking allows surgeons to evaluate their treatment decisions based on those of their colleagues, and also presents areas of dissimilarity that can be targeted for more extensive research.