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. 2024 Oct 7;12(10):23259671241274770.
doi: 10.1177/23259671241274770. eCollection 2024 Oct.

Trends in Anterior Cruciate Ligament Reconstruction Techniques and Postoperative Care Among Leaders in the Field: A Survey of the Herodicus Society

Ian D Engler  1   2 , Michael A Fox  1 , Andrew J Curley  1 , Damaris S Mohr  3 , Sahil Dadoo  1 , Justin W Arner  3 , Volker Musahl  1 , James P Bradley  3
Affiliations

Trends in Anterior Cruciate Ligament Reconstruction Techniques and Postoperative Care Among Leaders in the Field: A Survey of the Herodicus Society

Ian D Engler et al. Orthop J Sports Med. .

Abstract

Background: Despite a growing body of literature regarding anterior cruciate ligament reconstruction (ACLR), there remains a wide diversity in surgical technique and clinical practice across providers.

Purpose: To (1) describe current ACLR practice preferences among members of the Herodicus society and (2) determine whether these preferences are influenced by years in practice and overall surgical volume.

Study design: Cross-sectional study.

Methods: A 24-question survey investigating surgeons' practices and preferred ACLR surgical techniques was sent via email to all active Herodicus Society members. Survey responses were subdivided by years of experience and overall ACLR annual case volume. Descriptive statistics were compiled and chi-square testing was utilized to determine the significance of experience and case volume on survey responses.

Results: Of the 113 invited Herodicus Society members who perform ACLR, 69 (61%) completed the survey. Respondents had a mean ± SD of 30.9 ± 9.8 years of experience in clinical practice and performed a mean of 96.0 ± 50.7 primary and 21.6 ± 16.9 revision ACLR annually. Of revision cases, 72.1% were performed using a single-stage technique. Mean frequency of graft usage by surgeon was bone-patellar tendon-bone autograft (58.6%), quadriceps autograft (14.6%), hamstring tendon autograft (14.0%), and allograft (11.8%). The plurality of surgeons responded that they used anterolateral augmentation "rarely" in primary ACLR (39.1%) and "sometimes" in revision ACLR (31.9%), with the majority performing lateral extra-articular tenodesis (66.7%) rather than anterolateral ligament reconstruction (14.5%). Most surgeons would not allow a 20-year-old football player to return before 7 months after ACLR (71.0%) but highly valued return-to-sports testing to determine readiness (94.2%). Higher volume surgeons performed single-stage revision ACLR at a significantly higher rate (79.8% vs 62.9%, P = .02) and significantly differed in return-to-sports criteria, with a greater proportion relying primarily on biometric testing (P = .01).

Conclusion: The survey demonstrated that, in the Herodicus Society, a wide range of preferences exist regarding ACLR surgical technique. Bone-patellar tendon-bone autograft is the most frequent primary ACLR graft choice. Most participants have not embraced newer techniques such as anterolateral or suture tape augmentation. Return to sports is generally not allowed before 7 months and heavily factors-in return-to-sports testing metrics, suggesting that purely time-based criteria for return to sports is not modern practice among elite sports medicine surgeons.

Keywords: ACL; ACLR; Herodicus Society; graft choice; knee ligaments.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: I.D.E. has received education payments from Arthrex, Mid-Atlantic Surgical Systems, Smith+Nephew; hospitality payments from Stryker; and a grant from Arthrex. M.A.F. has received education payments from Mid-Atlantic Surgical Systems. A.J.C. has received education payments from Arthrex, Medwest Associates, Mid-Atlantic Surgical Systems, Smith+Nephew, Supreme Orthopedic Systems; hospitality payments from Stryker; and a grant from Arthrex. J.W.A. has received education payments from Mid-Atlantic Surgical Systems; hospitality payments from Arthrex, Mid-Atlantic Surgical Systems, Smith+Nephew; and grants from Arthrex and DJO. V.M. has received nonconsulting fees from Smith & Nephew and Synthes GmbH; and consulting fees from Smith & Nephew. J.P.B. has received consulting fees from Arthrex and DJO; nonconsulting fees from Arthrex; royalties from Arthrex; and education payments from Fones Marketing Management. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Graft choice frequency for ACLR among Herodicus members. ACLR, anterior cruciate ligament reconstruction; BPTB, bone–patellar tendon–bone.
Figure 2.
Figure 2.
Preferred BPTB graft fixation techniques for ACLR, with the y axis representing percentage of survey respondents. ACLR, anterior cruciate ligament reconstruction; BPTB, bone–patellar tendon–bone.
Figure 3.
Figure 3.
Preferred soft tissue (quadriceps and hamstring) graft fixation techniques for ACLR, with the y axis representing percentage of survey respondents. ACLR, anterior cruciate ligament reconstruction.
Appendix Figure A1.
Appendix Figure A1.
Survey administered to the Herodicus Society.
See this image and copyright information in PMC

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