Current practice variations in the management of anterior cruciate ligament injuries in Delhi

The purpose of this study was to analyze national surveys of orthopaedic surgeons on anterior cruciate ligament (ACL) reconstruction to determine their preferences related to the preferred graft, femoral tunnel positioning, fixation and tensioning methods, antibiotic and anti-thromboembolic prophylaxis, and use of tourniquet and drains. A systematic search of PubMed, Web of Science, and Cochrane Library was performed. Inclusion criteria were surveys of ACL reconstruction trends and preferences published in the past 5 years (2011–2016), involving members of national societies of orthopaedics. Information regarding survey modalities, population surveyed, graft choice both in the general or in the athletic population, surgical technique, fixation, use of antibiotic, tourniquet, drains, and anti-thromboembolic prophylaxis was extracted. Eight national surveys were included from Europe (three), North or Latin America (three), and Asia (two). Overall, 7,420 questionnaires were sent, and 1,495 participants completed the survey (response rate ranging from 16 to 76.6%). All surveys reported the hamstring tendon (HT) autograft as the preferred graft, ranging from 45 to 89% of the surveyed population, followed by bone-patellar tendon-bone (BPTB) graft (2–41%) and allograft (2–17%). Only two surveys focusing on graft choice in athletic population underlined how in high-demand sportive population the graft choices changes in favor of BPTB. Single-bundle reconstruction was the preferred surgical technique in the four surveys that investigated this issue. Five surveys were in favor of anteromedial (AM) portal and two in favor of trans-tibial technique. Suspension devices for femoral fixation were the preferred choice in all but one survey, while interference screws were the preferred method for tibial fixation. The two surveys that investigated graft tensioning were in favor of manual tensioning. The use of tourniquet, antibiotics, drains, and anti-thromboembolic prophylaxis were vaguely reported. A trend toward the preference of HT autograft was registered in all the surveys; however, sport participation has been highlighted as an important variable for increased use of BPTB. Single-bundle reconstruction with AM portal technique and suspension femoral fixation and screws fixation for the tibia seem the preferred solution. Other variables such as tensioning, antibiotic, anti-thromboembolic prophylaxis, tourniquet use, and drains were investigated scarcely among the surveys; therefore, no clear trends could be delineated. This is a Level V, systematic review of expert opinion study.

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“…Single-bundle reconstruction was the preferred technique in the four surveys that investigated this issue. 24 25 26 27 29…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported the technique for femoral tunnel drilling: five were in favor of anteromedial (AM) portal, 24 26 27 29 30 and the remaining two were in favor of trans-tibial technique. 28 31…”

Section: Resultsmentioning

confidence: 99%

New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years

Grassi

Carulli

Innocenti

et al. 2018

Joints

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“…11e14 Non-operative treatment of ACL rupture may enhance the sense of 'stability' to the injured knee but not on objective outcome assessment and rate of return to sports. 15,16 Arthroscopic reconstruction of the damaged ACL has been shown to effectively restore knee stability, prevent further knee damage and enhance the return to pre-injury full activities and return to high-level sporting activities.…”

Section: Introductionmentioning

confidence: 99%

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature

Vaishya

Esin

Agarwal

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2e4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19e39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.

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“…Among the current methods of anterior cruciate ligament reconstruction (ACLR), single-bundle(SB) reconstruction is performed by most surgeons [ 1 , 2 ]. During single-bundle ACLR, femoral tunnel location plays an important role in restoring the intact knee mechanisms, whereas malplacement of the tunnel was cited as the most common cause of knee instability [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The current femoral tunnel preparation focus has shifted from the TT method(with femoral tunnel location at the “over-the-top” position approximately 11 o’clock in the femoral notch of the right knee) toward the independent drilling method(with the femoral tunnel location at the center of the AM bundle of the ACL footprint approximately 9 o’clock in the femoral notch of the right knee) with restoration of the native ACL knee kinematics. The use of the AM portal drilling technique has increased in recent years from 68% of surgeons using this technique in 2013 [ 1 ] to 89.6% in 2016 [ 2 ]. Although the anatomic single-bundle ACLR procedure is currently in use, it remains controversial whether the AM technique is biomechanically superior compared with the TT method.…”

Section: Introductionmentioning

confidence: 99%

Tibiofemoral joint contact area and stress after single-bundle anterior cruciate ligament reconstruction with transtibial versus anteromedial portal drilling techniques

Liu¹,

Wang

et al. 2018

J Orthop Surg Res

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BackgroundDuring single-bundle ACLR, femoral tunnel location plays an important role in restoring the intact knee mechanisms, whereas malplacement of the tunnel was cited as the most common cause of knee instability. The objective of this study is to evaluate, objectively, the tibiofemoral contact area and stress after single-bundle (SB) anterior cruciate ligament reconstruction (ACLR) with femoral tunnel positions drilled by transtibial (TT) or anteromedial (AM) portal techniques.MethodsSeven fresh human cadaveric knees underwent ACLR by the use of TT or AM portal techniques in a randomized order. These specimens were reused for ACL-R (TT and AM). The tibiofemoral contact area and stresses were gauged by an electronic stress-sensitive film inserted into the joint space. The knee was under the femoral axial compressive load of 1000 N using a biomechanics testing machine at 0°, 10°, 20°, and 30° of flexion. Three conditions were compared: (1) intact ACL, (2) ACLR by the use of the TT method, and (3) ACLR by the use of the AM portal method.ResultsCompared with AM portal ACL-reconstructed knees, a significantly decreased tibiofemoral contact area on the medial compartment was detected in the TT ACL-reconstructed knees at 20°of knee flexion (P = .047). Compared with the intact group, the TT ACLR group showed a higher mean stress at 20° and 30° of flexion on the medial compartments (P = .001, P = .003, respectively), while the AM portal ACLR group showed no significant differences at 30° of flexion (P = .073). The TT ACLR group also showed a higher mean maximum stress at 20° of flexion on the medial compartments (P = .047), while the AM portal ACLR group showed no significant differences at this angle(P = .319).DiscussionThe alternation of the tibiofemoral joint contact area and stress in reconstructed knees may be caused by the mismatch of the tibiofemoral joint during knee movement procedures compared with intact knees.ConclusionsSB ACLR by the use of the AM portal method and TT method both alter the tibiofemoral contact area and stress when compared with the intact knee. When compared with the TT technique, ACLR by the AM portal technique more closely restores the intact tibiofemoral contact area and stress at low flexion angles.

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Current practice variations in the management of anterior cruciate ligament injuries in Delhi

Cited by 13 publications

References 37 publications

New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years

New Trends in Anterior Cruciate Ligament Reconstruction: A Systematic Review of National Surveys of the Last 5 Years

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature

Tibiofemoral joint contact area and stress after single-bundle anterior cruciate ligament reconstruction with transtibial versus anteromedial portal drilling techniques

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