RESUMO
ABSTRACT Objective: This study aims to establish the current panorama of the anterior cruciate ligament reconstruction surgery in Brazil. Methods: A survey that consisted of a 24-item questionnaire including surgeon's demographics, preferred technique, graft selection, graft positioning, use of braces, drains, antibiotic prophylaxis and most common complications was conducted at the last three editions of a national knee surgery event. Results: Six hundred eight questionnaires were analyzed. Brazilian knee surgeons are mostly male, with mean age of 42 years (26-68) and are affiliated to at least one orthopedic society. Thirty-six percent (36%) perform more than 50 reconstructions per year. The preferred graft is the hamstring tendons graft (64%). The frequency of use of anatomical technique increased approximately from 55% from 2011 to 2013, to 85.5% in 2015 (p<0.001). From 2011 to 2015, there was a progressive reduction from 56.8% to 18.1% in the frequency of use of transtibial femoral tunnel drilling (p<0.001). Conclusion: Our findings show that Brazilian knee surgeons' preferences are evolving according to the current world practice. Level of Evidence V, Economic and Decision analysis study.
RESUMO Objetivo: O presente estudo tem como objetivo estabelecer o panorama atual da cirurgia de reconstrução do ligamento cruzado anterior no Brasil. Métodos: Nas últimas três edições de um evento nacional de cirurgia do joelho, realizou-se uma pesquisa que consistiu em um questionário de 24 itens incluindo dados demográficos do cirurgião, técnica preferida, seleção do enxerto, posicionamento do enxerto, uso de órteses, drenos, profilaxia antibiótica e complicações mais comuns. Resultados: Seiscentos e oito questionários foram analisados. O cirurgião brasileiro de joelho é majoritariamente do sexo masculino, tem idade média de 42 anos (26-68) e é afiliado a pelo menos uma sociedade ortopédica. Trinta e seis por cento (36%) realizam mais de 50 reconstruções por ano. O enxerto preferido é o enxerto de tendões isquiotibiais (64%). A frequência de uso da técnica anatômica aumentou de 55% nos anos de 2011 e 2013 para 85,5% em 2015 (p<0,001). Após 2011, também foi observada redução progressiva de 56,8% para 18,1% até 2015 na frequência de uso da técnica de perfuração do túnel femoral transtibial (p<0,001). Conclusão: Nossos achados mostram que os cirurgiões brasileiros de joelho estão evoluindo de acordo com a prática mundial atual. Nível de evidência V, Análise econômica e de decisão.
RESUMO
AIM: To systematically review the incidence of ipsilateral graft re-rupture and contralateral anterior cruciate ligament (ACL) rupture following its reconstruction, with special attention to the femoral drilling technique. METHODS: Systematic review and meta-analysis of high-level prospective studies searched in MEDLINE database following PRISMA statement. The rate of ipsilateral graft re-rupture and contralateral rupture in patients submitted to either transtibial (TT) technique (isometric) or anteromedial (AM) technique (anatomic) was compared. RESULTS: Eleven studies met the criteria and were included in final analysis. Reconstructions using the AM technique had a similar chance of contralateral ACL rupture when compared to the chance of ipsilateral graft failure (OR = 1.08, P = 0.746). In reconstructions using TT technique, the chance of contralateral ACL rupture was approximately 1.5 times higher than ipsilateral graft failure (OR = 1.49, P = 0.048). Incidence of contralateral lesions were similar among the techniques TT (7.4%) and AM (7.0%) (P = 0.963), but a trend could be noticed with a lower incidence of lesion in the ipsilateral limb when using the TT technique (4.9%) compared to the AM technique (6.5%) (P = 0.081). CONCLUSION: ACL reconstruction by TT technique leads to lower incidence of graft re-injury than contralateral ACL lesion. There is no difference between the chance of re-injury after AM technique and the chance of contralateral ACL lesion (native ligament) with either technique.
