Analysis of Changing Practice Trends in Anterior Cruciate Ligament Reconstruction: A Multicenter, Single-Institution Database Analysis

Abstract

PurposeThis study sought to identify trends in anterior cruciate ligament (ACL) reconstruction (ACLR), including graft choice, femoral tunnel drilling, and augmentation techniques, and to assess how various surgeon factors impact these trends. MethodsA retrospective review of primary ACLR performed between 2014 and 2022 was performed using a multi-centered institutional database. Patient demographics, graft type, femoral drilling technique, use of extra-articular tenodesis, and use of suture augmentation were recorded from the medical record. Surgeon fellowship training (sports-trained versus non-sports-trained), experience (high: minimum 15 years in practice), and volume (high: minimum 15 ACLR per year) were used to stratify technique utilization. Z-test for proportions compared categorical variables. Pearson correlation analyses identified trends and assessed statistical significance, defined as a p-value less than 0.05. ResultsOur cohort consisted of 2,032 ACLR performed on 2,006 patients. The average patient age was 28.3 +/- 11.6 years, with more procedures performed on males (67.3%). The average surgeon experience was 19.7 +/- 11.4 years, with an average annual procedural volume of 4.0 +/- 5.4. Most surgeons were sports-trained (55, 64.7%), high experience (44, 57.1%), and low-volume (80, 94.1%). There were increasing annual proportion of ACLR performed by sports-trained (R=0.748, p=0.020) and low experience (R=0.940, p<0.001) surgeons. Autograft reconstructions were most often performed by sports-trained (71.2%), low experience (66.1%), and high-volume (76.9%) surgeons. There was an increasing proportion of autograft ACLR that utilized QT among sports-trained (R=0.739, p=0.023), high experience (R=0.768, p=0.016), and low-volume (R=0.785, p=0.012). Independent drilling (ID) techniques were used in an increasing proportion of ACLR performed by non-sports-trained (R=0.860, p=0.003) and high-volume surgeons (R=0.864, p=0.003). Augmentation of ACLR with concomitant suture augmentation (24, 1.2%) or extra-articular tenodesis (6, 0.3%) was rarely performed ConclusionIn our multi-centered institution, the QT autograft has been increasingly utilized in ACLR by sports-trained, low volume, and high experience surgeons, ID techniques have been increasingly utilized by non-sports-trained and high-volume surgeons Clinical RelevanceSurgeons must stay current with literature that affects their procedures to ensure that evidence-based medicine is being practiced.