Beliefs and attitudes of members of the American Academy of Orthopedic Surgeons regarding the treatment of anterior cruciate ligament injury
Beliefs and attitudes of members of the American Academy of Orthopedic Surgeons regarding the treatment of anterior cruciate ligament injury
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DOI：
10.1016/s0749-8063(03)00398-0
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发表时间：
2003-09-01
影响因子：
4.7
通讯作者：
Warren, RF
中科院分区：
文献类型：
--
作者：
Marx, RG;Jones, EC;Warren, RF
目的：本研究的目的是量化骨科医生对前交叉韧带（ACL）缺陷膝关节自然史、手术和康复以及这些患者治疗的一致性。研究类型：医生邮件调查。方法：从美国矫形外科学会（AAOS）目录中随机选择矫形外科医生。仅要求在过去一年内治疗或转介ACL不足患者接受治疗的个人完成3页的调查。该调查包括25个关于临床意见的问题。当80%或更多的外科医生同意相同的反应选项时，存在临床一致性。结果如下：回答调查的外科医生总数为397（回答率为54.8%），在过去一年中治疗或转诊ACL不足患者的人数为261。在完成调查问卷的外科医生中，对各个问题的回答率范围为92%至100%。所有问题的平均回答率为97.4%。外科医生的平均年龄为48.4岁，35.8%的人认为他们的实践是运动医学或膝关节手术的子专业。对于12个问题（48%），外科医生之间存在临床分歧。25个问题中有16个问题的手术量与临床意见相关（P小于或等于0.05）。结论：在AAOS成员中，关于ACL损伤的临床意见和决策存在显著差异，特别是关于ACL缺陷患者是否可以参加所有娱乐性体育活动、ACL重建是否可以降低关节病发生率以及术后使用支具。此外，外科医生不同意4种患者特征（年龄超过40岁、存在疼痛、不可修复的尿道撕裂、涉及工伤赔偿的损伤）对手术决定的影响。对于治疗前交叉韧带损伤的骨科医生来说，临床不确定性的领域应该是未来研究和医学教育的重点。
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 less than or equal to .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.