Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India

Abstract

Background Although guidelines from multiple scientific studies decide the general trend in ACLR practice, there is often a variation between scientific guidelines and actual practice. Methods A 17-member committee comprised of sports surgeons with experience of a minimum of 10 years of arthroscopy surgery finalized a survey questionnaire consisting of concepts in ACL tear management and perioperative trends, intraoperative and post-operative practices regarding single-bundle anatomic ACLR. The survey questionnaire was mailed to 584 registered sports surgeons in six states of south India. A single, non-modifiable response was collected from each member and analyzed. Results 324 responses were received out of 584 members. A strong consensus was present regarding Hamstring tendons preference for ACLR, graft diameter ≥ 7.5 mm, viewing femoral footprint through the anterolateral portal, drilling femoral tunnel from anteromedial portal guided by ridges and remnants of femoral footprint using a freehand technique, suspensory devices to fix the graft in femur and interference screw in the tibia and post-operative bracing. A broad consensus was achieved in using a brace to minimize symptoms of instability of an ACL tear and antibiotic soaking of graft. There was no consensus regarding the timing of ACLR, preferred graft in athletes, pre-tensioning, extra-articular procedure, and return to sports. There was disagreement over hybrid tibial fixation and suture tapes to augment graft. Conclusion Diverse practices continue to prevail in the management of ACL injuries. However, some of the consensuses reached in this survey match global practices. Contrasting or inconclusive practices should be explored for potential future research.

Kết Quả Phục Hồi Chức Năng Khớp Gối Trên Bệnh Nhân Phẫu Thuật Nội Soi Tái Tạo Đồng Thời Hai Dây Chằng Chéo Bằng Mảnh Ghép Tự Thân

“…Năm 2022, Jagadeesh báo cáo nghiên cứu sự liên quan giữa đường kính mảnh ghép với tỷ lệ mổ lại DCCT ghi nhận kết quả: đường kính <7mm là 21,3%, đường kính 7,1-8mm là 5,8% và đường kính 8,1-9mm là 2,6% [8]. Tác giả Pandey (2020) trong một nghiên cứu phẫu thuật tái tạo DCCS ghi nhận đường kính của mảnh ghép được chọn nên lớn hơn 9 mm vì chống lại lực hấp dẫn, mài mòn (tại góc "killer turn") [12]. Đường kính mảnh ghép trong nghiên cứu của chúng tôi chỉ đạt 7,35±0,37mm cho DCCT và 7,71±0,42mm cho DCCS nhỏ hơn so với các tác giả trên và thời gian theo dõi ngắn hơn do đó điểm Lysholm trung bình sau mổ thấp hơn nhưng kết quả chức năng KG đạt mức tương đồng.…”

“…Thời gian phẫu thuật trung bình là 112,5±12,2 phút (85-130). Tất cả 36 bệnh nhân có thời gian theo dõi ít nhất là 12 tháng và thời gian theo dõi trung 15,56±7,56 tháng(12)(13)(14)(15)(16)(17)(18).3…”

Anthropometry in predicting Semitendinosus and Gracilis graft diameter for arthroscopic ACL reconstruction among the Bengali population

“…[6] However, a diameter of ≥ 7.5 mm might be acceptable, as per the consensus of Indian surgeons. [7] Traditionally used 4-stranded (quadrupled hamstring) Semitendinosus tendon graft is a stronger graft and has good surgical outcomes; less anterior knee pain, fewer potential damages to the extensor mechanism, decreased donor-site morbidity, and an overall smooth surgical recovery. [8][9][10][11] Several other commonly used autografts namely grafts from the patellar tendon or quadriceps tendons, can be harvested effectively to an expected predetermined diameter.…”

“…[ 6 ] However, a diameter of ≥ 7.5 mm might be acceptable, as per the consensus of Indian surgeons. [ 7 ]…”