Large variation in indications, preferred surgical technique and rehabilitation protocol for primary anterior cruciate l
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Large variation in indications, preferred surgical technique and rehabilitation protocol for primary anterior cruciate ligament repair: a survey among ESSKA members Harmen D. Vermeijden1 · Xiuyi A. Yang1 · Jelle P. van der List1,2 · Gregory S. DiFelice1 Received: 17 February 2020 / Accepted: 16 April 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To assess current surgical preferences and practice patterns regarding primary anterior cruciate ligament (ACL) repair among European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members. Methods A web-based survey was designed, including questions regarding indications for primary repair, outcomes of primary repair, and rehabilitation protocols. An invitation for study participation was sent by email to all ESSKA e-mail contacts. Descriptive statistics were performed. Results A total of 169 surgeons responded to the survey (7% response rate of active members). Lack of supporting scientific evidence is the main reason for not using repair as a surgical treatment (63%). Most important indications were proximal avulsion tears (84%), younger age (49%), and older age (34%). Among those currently utilizing repair as a treatment option, transosseous tunnel fixation repair (34%) and repair with internal brace using transosseous tunnel fixation (32%) were the most preferred techniques. Eleven percent indicated dynamic intraligamentary stabilization as their preferred technique. A similar rate of progression for rehabilitation for repair and reconstruction techniques was noted among respondents. Conclusion This practice survey shows that the majority of surgeons indicated the main reason for not incorporating primary repair in their current practices was a lack of supporting scientific evidence. Among those holding favourable attitudes and beliefs, most surgeons indicated patients with proximal tears, younger-aged, and older-aged patients might be eligible for repair. Prospective studies with higher levels of evidence are warranted to establish guidelines for repair, including indications, optimal surgical technique, and rehabilitation protocols. Level of evidence V (expert opinion). Keywords Anterior cruciate ligament · Primary repair · Preferences · Technique · Rehabilitation · Survey
Introduction Reconstruction of the anterior cruciate ligament (ACL) with tendon grafts remains the current standard for treatment of ACL-deficient knees [5, 8, 13, 14, 23]. Over the last decade, however, there has been a resurgence of interest in primary repair in an attempt to preserve native tissue along with * Gregory S. DiFelice [email protected] 1
Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork‑Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021, USA
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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proprioceptive function [31]. Several rep
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