Current Practices in Anterior Cruciate Ligament Reconstruction in the U.S. Military

A Survey of the Society of Military Orthopaedic Surgeons

John Synovec, K. Aaron Shaw, Ivan J. Antosh, Jason Grassbaugh, Christopher J. Tucker, Stephen Arthur Parada, Edward Arrington

Research output: Contribution to journalArticle

Abstract

Introduction: The subject of anterior cruciate ligament reconstruction (ACLR) contains a large volume of research but very little consensus for ideal surgical technique, graft implementation, and fixation strategy for improved clinical outcome. Previous studies have assessed surgeon preferences for ACLR in civilian populations, but no study to date has examined ACLR trends in military surgeons caring for a unique, high functional demand population. Materials and Methods A 20 question survey was distributed to all members of the Society of Military Orthopaedic Surgeons (SOMOS) practicing orthopedic surgery at an Army medical treatment facility. Questions focused on graft preferences for ACLR according to age and gender groups, and fixation strategies for the femoral and tibial components. Responses were recorded via a survey application and statistical analysis of the responses was done to exam for trends. This study was exempt from IRB approval. Results Of the identified 131 surgeons, 56 were excluded, leaving 75 providers for study inclusion, with a 100% response rate. Surgeons preferred autograft for younger patients (80.5%) (patients ≤25 yr), whereas they relied on patient choice more commonly for older patients (51.9%). Surgeons preferred bone-patellar tendon-bone autograft for males ≤25 yr of age (51.3%) compared with 34.2% for females in the same age range. Independent femoral drilling was performed by 96.0% of surgeons for primary soft tissue ACL reconstructions. Suspensory fixation was the preferred fixation for soft tissue grafts (87.7%). Knee position for graft tensioning during tibial fixation varied between surgeons with the majority tensioning with the knee in 15-30 degrees of flexion (63.8%), following by <15 degrees (18.8%), and full extension (15%). Conclusion There was a general consensus in the technical components for ACLR performed among military orthopedic surgeons. Multicenter studies in the military are necessary to examine how these technical aspects of reconstruction are affecting the functional outcome of military service members undergoing ACLR.

Original languageEnglish (US)
Pages (from-to)E249-E255
JournalMilitary medicine
Volume184
Issue number1-2
DOIs
StatePublished - Jan 1 2019

Fingerprint

Anterior Cruciate Ligament Reconstruction
Transplants
Autografts
Thigh
Knee
Consensus
Bone and Bones
Patellar Ligament
Research Ethics Committees
Orthopedic Surgeons
Surveys and Questionnaires
Surgeons
Population
Multicenter Studies
Orthopedics
Age Groups
Research

Keywords

  • Anterior Cruciate Ligament
  • Graft Preference
  • Military
  • Reconstruction
  • Survey

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Current Practices in Anterior Cruciate Ligament Reconstruction in the U.S. Military : A Survey of the Society of Military Orthopaedic Surgeons. / Synovec, John; Shaw, K. Aaron; Antosh, Ivan J.; Grassbaugh, Jason; Tucker, Christopher J.; Parada, Stephen Arthur; Arrington, Edward.

In: Military medicine, Vol. 184, No. 1-2, 01.01.2019, p. E249-E255.

Research output: Contribution to journalArticle

Synovec, John ; Shaw, K. Aaron ; Antosh, Ivan J. ; Grassbaugh, Jason ; Tucker, Christopher J. ; Parada, Stephen Arthur ; Arrington, Edward. / Current Practices in Anterior Cruciate Ligament Reconstruction in the U.S. Military : A Survey of the Society of Military Orthopaedic Surgeons. In: Military medicine. 2019 ; Vol. 184, No. 1-2. pp. E249-E255.
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abstract = "Introduction: The subject of anterior cruciate ligament reconstruction (ACLR) contains a large volume of research but very little consensus for ideal surgical technique, graft implementation, and fixation strategy for improved clinical outcome. Previous studies have assessed surgeon preferences for ACLR in civilian populations, but no study to date has examined ACLR trends in military surgeons caring for a unique, high functional demand population. Materials and Methods A 20 question survey was distributed to all members of the Society of Military Orthopaedic Surgeons (SOMOS) practicing orthopedic surgery at an Army medical treatment facility. Questions focused on graft preferences for ACLR according to age and gender groups, and fixation strategies for the femoral and tibial components. Responses were recorded via a survey application and statistical analysis of the responses was done to exam for trends. This study was exempt from IRB approval. Results Of the identified 131 surgeons, 56 were excluded, leaving 75 providers for study inclusion, with a 100{\%} response rate. Surgeons preferred autograft for younger patients (80.5{\%}) (patients ≤25 yr), whereas they relied on patient choice more commonly for older patients (51.9{\%}). Surgeons preferred bone-patellar tendon-bone autograft for males ≤25 yr of age (51.3{\%}) compared with 34.2{\%} for females in the same age range. Independent femoral drilling was performed by 96.0{\%} of surgeons for primary soft tissue ACL reconstructions. Suspensory fixation was the preferred fixation for soft tissue grafts (87.7{\%}). Knee position for graft tensioning during tibial fixation varied between surgeons with the majority tensioning with the knee in 15-30 degrees of flexion (63.8{\%}), following by <15 degrees (18.8{\%}), and full extension (15{\%}). Conclusion There was a general consensus in the technical components for ACLR performed among military orthopedic surgeons. Multicenter studies in the military are necessary to examine how these technical aspects of reconstruction are affecting the functional outcome of military service members undergoing ACLR.",
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