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Published on: April 30, 2014
Preferences Including Graft Choice, Lateral Augmentation, and Rehabilitation After Anterior Cruciate Ligament
Sean Hazzard1, Blake Bacevich2, Mia Lustig1
1Department of Orthopaedic Surgery/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.
Purpose:
To assess current treatment preferences among National Football League (NFL) team orthopaedic knee surgeons for the management of anterior cruciate ligament (ACL) injuries.
Methods:
NFL team physicians who are sports medicine knee surgeons were identified by using public databases and emailed a multiple-choice poll evaluating various preferences involving treating ACL injuries in various situations.
Results:
Ninety-seven NFL team knee surgeons were identified, with 51 responding (53%). Respondent surgeons had 19.6 years of experience performing ACL surgery with 103.9 ACL reconstructions performed annually. Patella tendon was the favored graft in a 20-year-old running back, as well as the 25-year-old and 35-year-old recreational athlete. Quadriceps tendon became the second most favored graft in all situations. In total, 4% of surgeons said they would perform a primary repair of an ACL in the setting of a proximal tear in a 20-year-old running back, 96% said they would consider adding a lateral augmentation procedure in the primary ACLR setting but only if certain findings were obtained, 25% recommended outpatient physical therapy to supplement working with the team rehabilitation staff, whereas 76% did not recommend a brace for return to play.
Conclusions:
Patella tendon autograft is the favored graft in ACL reconstruction among professional and recreational athletes by NFL team orthopaedic knee surgeons. Quadriceps tendon autograft is the second most preferred graft. Lateral augmentation procedures would be considered in a primary ACLR but only if certain findings are present. Most respondents do not recommend supplementing rehab with outpatient PT or using a brace for return to play.
Clinical Relevance:
NFL team surgeons consider numerous factors when treating ACL injuries in professional athletes, including return to function, speed of recovery, and risk of reinjury, all of which directly impact the athlete's ability to sustain a livelihood during a relatively short professional career. Insights gained from these surgical practices may inform and enhance treatment strategies across a broader patient population.
