Current Practices in Anterior Cruciate Ligament Reconstruction in the US Military: A Survey of the Society of Military Orthopaedic Surgeons

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.