Current status of ACL reconstruction in Germany

Area of Science:

• Orthopedics
• Sports Medicine
• Surgical Techniques

Background:

• Anterior cruciate ligament (ACL) reconstruction involves numerous variables including graft choice, fixation methods, tunnel positioning, and surgical tools.
• Pre- and post-operative procedures, surgical indications, and surgeon/clinic factors contribute to treatment variability.
• Increasing ACL reconstructions necessitate descriptive statistics on current treatment implementation in Germany.

Purpose of the Study:

• To provide a descriptive statistical overview of current anterior cruciate ligament (ACL) reconstruction practices in Germany.
• To identify and analyze variations in surgical techniques, graft choices, and fixation methods used in ACL repair.
• To compare treatment approaches between high-volume and low-volume surgeons performing ACL reconstructions.

Main Methods:

• An online questionnaire was distributed to 709 clinics with orthopedic departments across Germany.
• The survey collected data on annual operations, surgeon numbers, operation duration, graft choices, tunnel construction, fixation techniques, graft failure, and infection rates.
• A response rate of 22% (n=155) was achieved, allowing for cross-comparison between high- and low-volume surgeons based on statistical records.

Main Results:

• German orthopedic surgeons perform an average of 35 ACL reconstructions annually, with an average operation time of 67 minutes.
• High-volume surgeons demonstrated shorter operation times for both primary (55 min) and revision (75 min) ACL reconstructions compared to low-volume surgeons (71 min and 90 min, respectively).
• Differences were observed in stability examination frequency (47% vs. 21%) and femoral drilling techniques (anterolateral portal use 71% vs. 54%), while graft choice and reasons for failure showed commonalities. Monofixation was predominant for both femoral (88%) and tibial (81%) fixation.

Conclusions:

• ACL tear treatment in German clinics exhibits significant variability in surgical approaches.
• The study provides the first descriptive statistical insight into the current landscape of ACL reconstruction in Germany.
• A specialized subgroup of surgeons with distinct expertise appears to exist within the broader population of ACL reconstruction practitioners.