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Article types. Research letters. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. Volume Issue 8. Increasing rates of anterior cruciate ligament reconstruction in young Australians, — Med J Aust ; 8 : Topics Sports medicine.
Surgical procedures, operative. Environment and public health. Musculoskeletal diseases. Abstract Objectives: To investigate the incidence and demographic features of anterior cruciate ligament ACL reconstructions in Australia by age and sex, and to determine whether the incidence has changed during the past 15 years.
View this article on Wiley Online Library. Competing interests:. Am J Sports Med ; High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from — to — time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports ; Shaw L, Finch CF. Trends in pediatric and adolescent anterior cruciate ligament injuries in Victoria, Australia — Comparison of four alternative national universal anterior cruciate ligament injury prevention programme implementation strategies to reduce secondary future medical costs.
Br J Sports Med ; High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis ; The long-term consequence of anterior cruciate ligament and meniscus injuries osteoarthritis.
Annual incidence of ACL injury and surgery in various populations. Res Sports Med ; Osteoarthritis Cartilage ; Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Jt Surg Am ; Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.
Factors associated with the epidemic of hospitalizations due to atrial fibrillation. Am J Cardiol ; National Centre for Classification in Health.
Eighth edition. National Casemix and Classification Centre. Eighth Edition. Australian Bureau of Statistics. Royal Australasian College of Surgeons; Medibank. Surgical variance report orthopaedic surgery. ACL tears in school-aged children and adolescents over 20 years. Pediatrics ; Trends in anterior cruciate ligament reconstruction in the United States. Orthop J Sports Med ; 3: Incidence and trends of anterior cruciate ligament reconstruction in the United States. Our website uses cookies to enhance your experience.
By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Figure 1. View Large Download. Figure 2. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train.
PubMed Google Scholar. Interventions designed to prevent anterior cruciate ligament injuries in adolescents and adults: a systematic review and meta-analysis. Am J Sports Med. PubMed Google Scholar Crossref. Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a meta-analysis. PLoS One. A systematic review of validated methods for identifying orthopedic implant removal and revision using administrative data.
Pharmacoepidemiol Drug Saf. The implementation of musculoskeletal injury-prevention exercise programmes in team ball sports: a systematic review employing the RE-AIM framework. Sports Med. Finch CF. No longer lost in translation: the art and science of sports injury prevention implementation research. Br J Sports Med. Save Preferences. Privacy Policy Terms of Use.
All surgeons employed an interference screw for BPTB tibial fixation with The majority of surgeons Bone grafting of bone plug harvest sites for BPTB reconstructions was performed by Autograft was the most commonly used BPTB reconstruction Of the respondents, Surgeon responses to the minimal soft tissue autograft diameter before they would perform an allograft augmentation are summarized in Figure 1.
A minority of surgeons Summary of surgeon responses to minimal soft tissue graft diameter during an autograft reconstruction before which they would augment with an allograft tendon. Our goal with this study was to query military orthopedic surgeons to determine trends in primary ACL reconstruction for military service members. With such an overwhelming number of manuscripts generated annually focused on ACL reconstruction and, in some instances, technical details about the surgery, it is imperative that providers understand current trends and general concepts so that they may effectively and accurately counsel their patients prior to proceeding with surgery.
With this in mind, we designed this survey to obtain a consensus regarding broad treatment strategies among military orthopedic surgeons in primary ACL reconstruction. We hypothesized that autograft would be heavily favored in young patients and that independent drilling techniques would be utilized primarily.
Treatment of ACL injuries has undergone a significant evolution from the era of ACL repair described by Feagin and Curl 13 to the modern era with a vast and sometimes overwhelming array of graft choices, fixation options, and techniques.
In , Bilko et al presented the results of an ACL survey administered to 50 world renowned knee surgeons. Survey studies remain a useful tool to identify current treatment trends for common surgical procedures such as ACLR and provide a baseline with which to compare past and future research. ACL injuries continue to be exceedingly common among military members. In turn, orthopedic caseloads at military treatment facilities MTFs tend to be very heavily sports oriented and reflective of the demanding nature of military service.
Similarly, Bottoni et al 21 reported a three times higher failure rate for allograft posterior tibialis versus autograft hamstring in a randomized clinical trial. Autograft tended to be heavily favored in this study: Surgeons recommended BPTB autograft in young active males less than 25, while autograft hamstring was most favored in active females in both the less than 25 and 26—35 yr groups.
This trend likely reflects multiple recent studies citing increased risk of failure with allograft in young, active patients, including several large studies by the MOON Multicenter Orthopaedic Outcomes Network Knee group.
Reconstructive technique recommendations by military surgeons appeared largely reflective of the current trends in ACL literature. Femoral independent drilling techniques were nearly universally reported among military surgeons — transtibial technique was reported by only 1. Independent techniques have been reported to provide superior anatomic graft positioning and biomechanical stability, although conclusive differences in clinical outcomes between techniques have not been elucidated.
Several studies have cited tunnel widening with older generation bioabsorbable screws compared with metal screws; however, no differences in clinical outcomes have been definitively reported. Collection of adequate autograft bone can be difficult with anteromedial portal and retrograde drilling techniques secondary to drilling inside the joint first and the effects of arthroscopic fluid, and this may necessitate alternative grafting modalities more frequently.
This has not been well studied, although some newer techniques using substitutes such as beta-tricalcium phosphate as well as biologics such as platelet rich plasma do show some promise. Knee flexion positioning during tibial fixation varied greatly, although most surgeons recommended tensioning and securing the tibial side at 15—30 degrees flexion.
Fifteen percent of surgeons tensioned the graft with the knee in full extension. Some previous studies have cited the potential for overconstraint with knee flexion and have advocated fixation in full extension to avoid potential flexion contracture.
All-inside ACLR techniques have recently gained considerable attention in the orthopedic literature, and this study demonstrates those techniques also gaining some momentum among military surgeons. This technique has increased in popularity secondary to its less invasive nature smaller incisions, potential for less pain, cosmetically appealing and use of sockets instead of complete tunnels which allow for bone preservation.
Early studies cite excellent short-term patient outcomes, comparable biomechanical stability to conventional techniques, and improved graft incorporation compared to aperture screw fixation. All-inside BPTB techniques rely on suspensory loop fixation through a single fixation point in the femoral bone plug and have not been well studied yet biomechanically or clinically. More high quality and comparative studies are necessary to evaluate the utility of all-inside techniques in young, active patients and high demand populations such as the military.
Additionally, this study samples a surgeon cohort that cares for a high demand, athletic population and treats a large number of ACL injuries in comparison with civilian counterparts. The identification of current treatment trends is vital to guide surgeons in providing the most up-to-date counseling and surgery to their patients.
This study also allows surgeons to identify areas of deficiency in the current ACL literature to guide future research. This information does have implications for post-graduate resident educations. The Army currently has six locations for post-graduate training in orthopedic surgery with resident education occurring in both military and civilian training institutions, allowing for diversity of clinical exposure.
Military orthopedic surgeons are in a unique position due to the population they service. The population is young, relatively healthy, and physically fit individuals.
This makes for an ideal group for research as evident with numerous military orthopedic publications regarding ACLR. With frequent publications, Army orthopedic surgeons have shown its focus on continuing to improve upon current practices in ACLR. Similarly, the survey highlighted several examples of Army orthopedic surgeons responsiveness to changing trends in ACLR to include the recommendation BPTB autograft in young active males less than 25 yr old and autograft hamstring for active females less than 35 yr old.
This recommendation preference is born out of multiple large studies showing increased risk of failure with allograft reconstructions in young, active patients. This shows is another example of Army Orthopaedics responsiveness to literature and emerging technologies. There are numerous limitations of this study. The survey was designed specifically for this study and has not been formally validated.
Comparisons to other ACL survey studies may be limited as a result. There was also potential for significant variability in interpreting questions that could influence reliability of the data. We found that there was a general consensus in the technical components for ACLR performed among military orthopedic surgeons.
An autograft ACLR was the preferred technique for younger patients, without gender differences, while surgeons tended to allow patients to make an informed choice for graft subtypes in older patients undergoing ACLR.
Independent femoral drilling is nearly universal among surgeons caring for these active, high-risk patients with a growing number of surgeons performing an all-inside reconstruction. Future studies are needed to ascertain how these technical aspects of the reconstruction affect the functional outcomes of military service members undergoing ACLR. Arthroscopy ; 18 : — 9. Google Scholar. Arthroscopy ; 33 11 : — Madick S : Anterior cruciate ligament reconstruction of the knee.
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