Current practices and opinions in ACL reconstruction and rehabilitation: results of a survey of the American Orthopaedic Society for Sports Medicine.

Many different surgical techniques and rehabilitation protocols have evolved for the treatment of anterior cruciate ligament (ACL) injuries, and there is a lack of agreement as to which approach results in the best outcome. Members of the American Orthopaedic Society for Sports Medicine (AOSSM) were surveyed to determine their current ACL reconstruction technique and opinions regarding preoperative and postoperative management. In 1999, members of the AOSSM were mailed surveys asking about their current treatment of ACL injuries. Approximately 76% of the active members responded to the survey, of which a large percentage (92%) currently performs ACL reconstructions. Both the experience of the surgeon and annual number of ACL reconstructions performed were recorded. Most responding surgeons routinely perform ACL reconstructions 3-6 weeks following an acute ACL injury using an endoscopic technique. Bone-patellar tendon-bone (BPTB) with interference screw fixation was the technique of choice for most respondents, with the majority performed on an outpatient basis. Rehabilitation protocols showed more variation regarding postoperative weight bearing, immobilization and bracing, length of physical therapy, and return to sport. Most surgeons prefer early postoperative full weight bearing with an average of 3.8 weeks of postoperative bracing. Physical therapy typically ranged from 1-4 months with return to sport at 6-7 months, generally with a functional brace. Patients with BPTB reconstruction were allowed the earliest return to full activity. Although previous clinical and biomechanical studies show good-excellent results with different ACL reconstruction and rehabilitation techniques, currently most surgeons practicing as members of the AOSSM continue to prefer BPTB grafts with metal interference screw fixation. However, there is less consensus regarding the specific postoperative rehabilitation protocol.