Treatment of Acute vs. Chronic ACL Injured/Deficient Knee
Part 1: Demographics
1.
What is your current age?
under 30
31-40
41-50
51-60
over 61
2.
Where do you currently practice?
United States
Canada
Central or South America
Europe
Asia
Africa
Middle East
3.
How long have you been in independent practice?
<5 years
5-10 years
11-20 years
>20 years
4.
Which best describes your current practice setting?
Community-based
Hospital-based
Non-operative
5.
Which best describes your current practice remuneration?
Private medicine
Public medicine
Mixed private/public
6.
Which best describes your practice type?
Academic
Non-academic
7.
Which of the following Orthopaedic Surgery accredited Fellowships have you completed:
Sports Medicine
Foot and ankle
Trauma
Arthroplasty/Adult reconstruction
Spine
Other (please specify)
8.
How many ACL reconstructions do you perform a year?
<10
10-25
26-50
51-100
>100
9.
Do you perform more than six of the following procedures per year?
Yes
No
Cartilage repair not including microfracture (MACI, OATS – allograft or autograft, AMIC, ACI)
Yes
No
Knee joint replacement (including UKA, TKA)
Yes
No
Osteotomy around the knee (HTO, DFO)
Yes
No
PART 2: ACL INJURY DIAGNOSIS/CLASSIFICATION IN YOUR PRACTICE
10.
How long after an initial ACL injury would you consider the knee “
chronically
” ACL deficient?
After 6 weeks
After 3 months
After 6 months
More than 1 year
Non-time-based factor:
11.
For an isolated ACL Injury you intend to reconstruct, what is the ideal time period for surgery?
<3 weeks
3-6 weeks
6-12 weeks
>12 weeks
12.
What proportion of symptomatic acute ACL injuries (according to your definition of acuity) do you treat surgically?
<10%
10-25%
25-50%
50-75%
>75%
13.
What proportion of symptomatic chronic ACL injuries (according to your definition of chronic) that you assess for the 1st time do you treat surgically?
<10%
10-25%
25-50%
50-75%
>75%
14.
For what you consider an
“ACUTE”
ACL deficient/injured knee, which of the following investigations do you routinely obtain? Check all that apply.
Weight bearing knee X-rays
Non-weight bearing knee X-rays
Standing lower extremity alignment X-rays (whole leg)
MRI
CT
Ultrasound
Other (please specify)
15.
For what you consider an
“ACUTE”
ACL deficient knee, how likely are you to perform the following calculation during the assessment?
Never
Rarely
Sometimes
Often
Always
Posterior Tibial slope calculation
Never
Rarely
Sometimes
Often
Always
Coronal plane alignment on full-length standing x-ray
Never
Rarely
Sometimes
Often
Always
Kellgren-Lawrence OA grading on PA flexion weight bearing views
Never
Rarely
Sometimes
Often
Always
16.
For what you consider a
“CHRONIC”
ACL deficient/injured knee, which of the following investigations do you routinely obtain? Check all that apply.
Weight bearing knee X-rays
Non-weight bearing knee X-rays
Standing lower extremity alignment X-rays (whole leg)
MRI
CT
Ultrasound
Other (please specify)
17.
For what you consider a
“CHRONIC”
ACL deficient knee, how likely are you to perform the following calculation during the assessment?
Never
Rarely
Sometimes
Often
Always
Posterior Tibial slope calculation
Never
Rarely
Sometimes
Often
Always
Coronal plane alignment on full-length standing X-ray
Never
Rarely
Sometimes
Often
Always
Kellgren-Lawrence OA grading on PA flexion weight bearing views
Never
Rarely
Sometimes
Often
Always
18.
In selecting treatment for an
"ACUTE"
ACL injured/deficient knee how important are the following anatomic factors in determining whether you would perform ACL reconstruction?
Very Important
Important
Moderately Important
Slightly Important
Not Important
Posterior Tibial slope
Very Important
Important
Moderately Important
Slightly Important
Not Important
Coronal plane alignment
Very Important
Important
Moderately Important
Slightly Important
Not Important
Degree of arthritis by KL scale
Very Important
Important
Moderately Important
Slightly Important
Not Important
Status of the medial meniscus -- i.e., torn vs intact
Very Important
Important
Moderately Important
Slightly Important
Not Important
High grade pivot-shift
Very Important
Important
Moderately Important
Slightly Important
Not Important
Hyperextension >5 degrees
Very Important
Important
Moderately Important
Slightly Important
Not Important
19.
In selecting treatment for
"CHRONIC"
ACL deficient knee, how important are the following anatomic factors in determining whether you would perform ACL reconstruction?
Very Important
Important
Moderately Important
Slightly Important
Not Important
Posterior Tibial slope
Very Important
Important
Moderately Important
Slightly Important
Not Important
Coronal plane alignment
Very Important
Important
Moderately Important
Slightly Important
Not Important
Degree of arthritis by KL scale
Very Important
Important
Moderately Important
Slightly Important
Not Important
Status of the medial meniscus -- i.e., torn vs intact
Very Important
Important
Moderately Important
Slightly Important
Not Important
High grade pivot-shift
Very Important
Important
Moderately Important
Slightly Important
Not Important
Hyperextension >5 degrees
Very Important
Important
Moderately Important
Slightly Important
Not Important
PART 3: ACL TREATMENT
20.
Does the length of time from injury (i.e., how you have defined acute vs chronic) influence your graft choice in ACLR?
No
Yes
21.
If yes to previous question (#20), what is your preferred graft choice in
"ACUTE"
ACLR reconstruction?
Autograft hamstring
Autograft quads
Autograft btb
Allograft
Other (please specify)
22.
If yes to previous question (#20), what is your preferred graft choice in
"CHRONIC"
ACLR reconstruction?
Autograft hamstring
Autograft quads
Autograft btb
Allograft
Other (please specify)
23.
In an
“ACUTE”
ACL injured/deficient knee, which of the following augmentation procedures are you likely to perform in addition to ACLR?
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
AL reconstruction or LET
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Internal brace
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Limb re-alignment in the coronal plane
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Limb re-alignment in the sagittal plane
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
24.
In a
“CHRONIC”
ACL deficient knee, which of the following augmentation procedures are you likely to perform in addition to ACLR?
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
ALL reconstruction or LET
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Internal brace
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Limb re-alignment in the coronal place
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Limb re-alignment in the sagittal plane
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
25.
If you perform sagittal limb re-alignment surgery in a
"CHRONIC"
ACL deficient knee, what is your threshold requiring an osteotomy for slope correction?
I do not perform limb re-alignment in chronic ACL deficient knee
<12 degrees
>12 degrees
Other (please specify)
26.
How likely would you be to consider coronal plane re-alignment osteotomy in the
"CHRONIC"
ACL deficient knee with"
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Kellgren-Lawrence grade <3 in the affected compartment
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Kellgren-Lawrence grade ≥3 in the affected compartment
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
Mechanical Axis Deviation of >15mm
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
PART 4: PATIENT COUNSELLING
27.
Do you counsel patients differently on their expected surgical outcomes based on whether an ACL injury is
"ACUTE"
vs.
"CHRONIC"
?
Yes
No
28.
How confident are you in the following outcomes of ACLR for an
"ACUTE"
ACL injury?
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
High patient satisfaction
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Return to sport at pre-injury level
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Graft rupture
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Decreased risk of OA progression
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
29.
How confident are you in the following outcomes of ACLR for a
"CHRONIC"
ACL injury?
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
High patient satisfaction
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Return to sport at pre-injury level
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Graft rupture
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
Decreased risk of OA progression
Very Confident
Confident
Moderately Confident
Slightly Confident
Not Confident
30.
Do you consider that an
"ACUTE"
vs
"CHRONIC"
ACL deficient knee as having unique anatomical differences?
Yes
No
31.
If yes to #27, which of the following anatomic factors do you recognize as important in considering the treatment of or prognosis of
"CHRONIC"
ACL deficiency?
Very Important
Important
Moderately Important
Slightly Important
Not Important
Cartilage lesions
Very Important
Important
Moderately Important
Slightly Important
Not Important
Anterior translation of the tibia with respect to the femur on X-ray
Very Important
Important
Moderately Important
Slightly Important
Not Important
Anterior translation of the tibia with respect to the femur on MRI
Very Important
Important
Moderately Important
Slightly Important
Not Important
Medial meniscal posterior horn tears
Very Important
Important
Moderately Important
Slightly Important
Not Important
Vertical oriented PCL on MRI
Very Important
Important
Moderately Important
Slightly Important
Not Important
Lateral meniscus posterior horn root tear
Very Important
Important
Moderately Important
Slightly Important
Not Important
Current Progress,
0 of 31 answered
