Indian Journal of Orthopaedics ( IF 1.1 ) Pub Date : 2022-08-20 , DOI: 10.1007/s43465-022-00719-z Vivek Pandey 1 , Sandesh Madi 1 , Chirag Thonse 2 , Clement Joseph 3 , David Rajan 4 , Jacob Varughese 5 , Jai Thilak 6 , P S Jayaprasad 7 , Kiran Acharya 1 , Krishna Gopal Ramamurthy 8 , Raghuveer Reddy 9, 10, 11 , Rajkumar Amravathi 12 , Sharath Rao 1 , Sridhar Gangavarapu 13 , Moparthi Srinivas 14 , Sujit Jose 15 , S R Sundararjan 16
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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.
中文翻译：
印度南部六个州的关节镜外科医生在成人患者中的主要解剖单束前交叉韧带重建实践趋势
背景
尽管来自多项科学研究的指南决定了 ACLR 实践的总体趋势，但科学指南与实际实践之间通常存在差异。
方法
由具有至少 10 年关节镜手术经验的运动外科医生组成的 17 人委员会最终完成了一份调查问卷，其中包括 ACL 撕裂管理和围手术期趋势、术中和术后单束解剖 ACLR 实践的概念。调查问卷已邮寄给印度南部六个州的 584 名注册运动外科医生。从每个成员那里收集一个单一的、不可修改的响应并进行分析。
结果
在 584 名成员中收到了 324 份回复。对于腘绳肌腱优先选择 ACLR、移植物直径 ≥ 7.5 mm、通过前外侧入口观察股骨足迹、使用徒手技术从股骨脊和残余股骨足迹引导的前内侧入口钻孔股骨隧道、悬吊装置固定股骨中的移植物和胫骨中的干扰螺钉和术后支撑。在使用支具以最大程度地减少 ACL 撕裂和抗生素浸泡移植物的不稳定症状方面达成了广泛共识。对于 ACLR 的时机、运动员首选的移植物、预紧、关节外手术和重返运动，尚未达成共识。对于混合胫骨固定和缝合胶带以增加移植物存在分歧。
结论
在 ACL 损伤的管理中，不同的做法继续盛行。然而，本次调查达成的一些共识符合全球惯例。对于未来的潜在研究，应探索对比或不确定的做法。
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