Editorial Commentary: Analysis of Practice Patterns and Changes for Anterior Cruciate Ligament Surgery Document the Past and Present, but High-Quality Data Should Inform the Future.

Abstract

Trends in practice patterns for anterior cruciate ligament surgery can give us a real-world look at what surgeons are actually doing. When large institutional studies show changing practice patterns over time, we can use those data to help benchmark our own practices. Innovations are inspired by colleagues, published literature, and industry, and not all innovation is positive. A return to independent drilling of the femoral and tibial tunnels reverses a single-incision trend that was less anatomic. Although hamstring tendon grafts are a popular graft choice, hamstring tendon grafts are associated with greater revision rates, and high-volume surgeons prefer bone-patellar tendon-bone and quadriceps tendon and autografts in general. Additional data are required to determine the benefit of quadriceps tendon and of lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction. Although a first step is to identify current practice patterns, the most important step is to develop high-quality outcome data, which can be used to inform surgeons so they can individualize and optimize surgery for their patients.