Abstract
Objective: To outline the current practice in the management of anterior cruciate ligament (ACL) injuries in the United Kingdom.
Methods: A postal questionnaire designed to include various clinical scenarios was sent out to the 321 orthopaedic surgeons in the United Kingdom who, being affiliated to one of the specialist societies of the British Orthopaedic Association, namely the British Association for Surgery of the Knee (BASK) or the British Orthopaedic Sports Trauma Association (BOSTA), have a manifested interest in treating such injuries.
Results: The response rate was 60% (192/321). Most surgeons diagnose and operate on less than 50 ACL injuries a year. The following results were obtained: 58% (76/132) use bone-patellar tendon-bone autografts, whereas 33% (44/132) use semitendinosis/gracilis autografts; 84% (108/129) would not incorporate the ACL remnant in the reconstruction; 14% (19/135) would perform an ACL reconstruction in an 8 year child with an acute rupture; 30% (42/141) would perform an ACL reconstruction in a 14 year old with an acute ACL rupture.
Conclusions: There is wide variation in the management of acute and chronic ACL injuries among orthopaedic surgeons in the British Isles. Future research and randomised controlled trials should address the issues that this investigation has raised.
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Selected References
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- Aglietti P., Buzzi R., D'Andria S., Zaccherotti G. Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1993 Mar;(288):195–204. [PubMed] [Google Scholar]
- Aichroth P. M., Patel D. V., Zorrilla P. The natural history and treatment of rupture of the anterior cruciate ligament in children and adolescents. A prospective review. J Bone Joint Surg Br. 2002 Jan;84(1):38–41. doi: 10.1302/0301-620x.84b1.11773. [DOI] [PubMed] [Google Scholar]
- Bollen S. R., Scott B. W. Rupture of the anterior cruciate ligament--a quiet epidemic? Injury. 1996 Jul;27(6):407–409. doi: 10.1016/0020-1383(96)00033-2. [DOI] [PubMed] [Google Scholar]
- Buss D. D., Min R., Skyhar M., Galinat B., Warren R. F., Wickiewicz T. L. Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med. 1995 Mar-Apr;23(2):160–165. doi: 10.1177/036354659502300206. [DOI] [PubMed] [Google Scholar]
- Caborn D. N., Johnson B. M. The natural history of the anterior cruciate ligament-deficient knee. A review. Clin Sports Med. 1993 Oct;12(4):625–636. [PubMed] [Google Scholar]
- Clark C. R., Heckman J. D. Volume versus outcomes in orthopaedic surgery: a proper perspective is paramount. J Bone Joint Surg Am. 2001 Nov;83-A(11):1619–1621. doi: 10.2106/00004623-200111000-00001. [DOI] [PubMed] [Google Scholar]
- Graf B. K., Lange R. H., Fujisaki C. K., Landry G. L., Saluja R. K. Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment. Arthroscopy. 1992;8(2):229–233. doi: 10.1016/0749-8063(92)90041-9. [DOI] [PubMed] [Google Scholar]
- Gómez-Castresana F. B., Bastos M. N., Sacristán C. G. Semitendinosus Kennedy ligament augmentation device anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1992 Oct;(283):21–33. [PubMed] [Google Scholar]
- Johnson D. L., Warner J. J. Diagnosis for anterior cruciate ligament surgery. Clin Sports Med. 1993 Oct;12(4):671–684. [PubMed] [Google Scholar]
- Kumar K., Maffulli N. The ligament augmentation device: an historical perspective. Arthroscopy. 1999 May;15(4):422–432. doi: 10.1016/s0749-8063(99)70061-7. [DOI] [PubMed] [Google Scholar]
- Learmonth D. J. Incidence and diagnosis of anterior cruciate injuries in the accident and emergency department. Injury. 1991 Jul;22(4):287–290. doi: 10.1016/0020-1383(91)90007-2. [DOI] [PubMed] [Google Scholar]
- Lo I. K., Kirkley A., Fowler P. J., Miniaci A. The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy. 1997 Oct;13(5):627–634. doi: 10.1016/s0749-8063(97)90191-2. [DOI] [PubMed] [Google Scholar]
- Maffulli N., Binfield P. M., King J. B., Good C. J. Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases. J Bone Joint Surg Br. 1993 Nov;75(6):945–949. doi: 10.1302/0301-620X.75B6.8245089. [DOI] [PubMed] [Google Scholar]
- Mirza F., Mai D. D., Kirkley A., Fowler P. J., Amendola A. Management of injuries to the anterior cruciate ligament: results of a survey of orthopaedic surgeons in Canada. Clin J Sport Med. 2000 Apr;10(2):85–88. doi: 10.1097/00042752-200004000-00001. [DOI] [PubMed] [Google Scholar]
- Shelbourne K. D., Wilckens J. H., Mollabashy A., DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991 Jul-Aug;19(4):332–336. doi: 10.1177/036354659101900402. [DOI] [PubMed] [Google Scholar]
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