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. 2021 Nov;6(6):322-328.
doi: 10.1136/jisakos-2020-000567. Epub 2021 Jul 16.

ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group

Seth L Sherman  1 , Jacob Calcei  2 , Taylor Ray  3 , Robert A Magnussen  4 , Volker Musahl  5 , Christopher C Kaeding  4 , Mark Clatworthy  6 , John A Bergfeld  7 , Marcus P Arnold  8
Affiliations
Free article

ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group

Seth L Sherman et al. J ISAKOS. 2021 Nov.
Free article

Abstract

Objectives: The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG).

Methods: A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more.

Results: The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%).

Conclusion: We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR.

Level of evidence: Level V, Expert Opinion.

Keywords: anterior cruciate ligament; knee.

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Conflict of interest statement

Competing interests: VM declares consulting fees from Smith & Nephew. MPA declares consulting fees from ConforMIS and Symbios ORIGIN. MC declares fellowship funding, payment or honoraria for lectures, presentations, speakers buereaus, manuscript writing or education events and consulting fees from DePuy Synthes; royalties or licenses with Arthrex; stock or stock options with Johnson & Johnson. SLS is a board or committee member of AAOS, ACL Study Group, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Epic Bio, International Cartilage Regeneration & Joint Preservation Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Joint Restoration Foundation and Vericel; on an editorial or governing board with American Journal of Orthopaedics and Arthroscopy; a paid consultant for Arthrex, BioVentus, Sparta Biomedical, Reparel, NewClip, Ceterix Orthopaedics, Conmed, Flexion Therapeutics, GLG Consulting, Linvatec, Moximed, Olympus, RTI Surgical, Smith & Nephew, Vericel and Zimmer; a paid presenter or speaker for Arthrex, Conmed, Flexion Therapeutics, Joint Restoration Foundation, Smith & Nephew and Vericel; has stock or stock options with Vericel and Epic Bio; has IP royalties with Conmed and receives research support from Arthrex.

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