Original article
Beliefs and attitudes of members of the American Academy of orthopaedic surgeons regarding the treatment of anterior cruciate ligament injury☆

Presented in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Francisco, California, March 2001.
https://doi.org/10.1016/S0749-8063(03)00398-0Get rights and content

Abstract

Purpose: The purpose of the study was to quantify the amount of agreement among orthopaedic surgeons regarding the natural history of the anterior cruciate ligament (ACL)-deficient knee, surgery, and rehabilitation, and the treatment of these patients. Type of Study: Physician mail survey. Methods: Orthopaedic surgeons were randomly selected from the American Academy of Orthopaedic Surgeons (AAOS) directory. Only individuals who treated or referred ACL-insufficient patients for treatment within the past year were asked to complete the 3-page survey. The survey included 25 questions regarding clinical opinion. Clinical agreement was present when 80% or more of the surgeons agreed on the same response option. Results: The total number of surgeons who responded to the survey was 397 (response rate, 54.8%) and the number who had treated or referred ACL-insufficient patients in the past year was 261. Among surgeons who completed the questionnaire, the response rates to the individual questions ranged from 92% to 100%. The mean response rate for all questions was 97.4%. The mean age of the surgeons was 48.4 years, and 35.8% considered their practice to be a subspecialty in sports medicine or knee surgery. For 12 questions (48%), there was clinical disagreement among the surgeons. Surgical volume was associated with clinical opinion for 16 of 25 questions (P ≤ .05). Conclusions: Significant variation is seen in clinical opinion and decision-making regarding ACL injuries among members of the AAOS, particularly regarding whether ACL-deficient patients can participate in all recreational sports activities, that ACL reconstruction reduces the rate of arthrosis, and on the use of braces in the postoperative period. Additionally, surgeons disagreed on the effect of 4 patient characteristics (age over 40, presence of pain, irreparable meniscal tear, injury involving Workers’ Compensation) on the decision to perform surgery. Areas of significant clinical uncertainty should be the focus of future research and medical education for orthopaedic surgeons who treat ACL injuries.

Section snippets

Methods

A mail survey of a random sample of members of the American Academy of Orthopaedic Surgeons (AAOS) was used to determine their attitudes regarding the natural history of the ACL-deficient knee, surgery, and rehabilitation. A random number generator (SPSS, Chicago, IL) was used to select 725 orthopaedists at random from the most recent AAOS directory (approximately 4%).20 The survey was conducted in late 1998 and early 1999.

A survey that could be completed in 10 minutes or less was sought to

Results

The survey was sent to 500 orthopaedic surgeons, selected at random from the AAOS directory. Of the surgeons who initially responded, 190 had treated or referred ACL-insufficient patients in the past year. A second mailing to an additional 225 surgeons was performed to try to obtain a total of 250 surgeons who had treated or referred patients for an ACL injury in the past year.

A total of 397 surgeons responded (54.8%). Of these respondents, 112 had not treated or referred patients for ACL

Discussion

The response rate for this survey was 54.8%, which is higher than other physician surveys that have been recently reported.1, 21, 22 There are several possible explanations for this finding. First, orthopaedic surgeons who treat these patients are interested in this topic, and therefore, they were motivated to take the time to complete the questions. Second, the survey was short and could generally be completed in less than 10 minutes. Finally, the senior author signed the letter that was sent

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    ☆

    Dr. Marx was supported by an American Academy of Orthopaedic Surgeons Health Services Research Fellowship and a Royal College of Physicians and Surgeons of Canada Detweiler Travelling Fellowship. Supported in part by a grant from Breg Inc., Vista, California.

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    Copyright © 2003 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.