Tendencias en Reconstrucción en Ligamento Cruzado Anterior: Encuesta a 103 Cirujanos

Resumen

Objetivo Describir las tendencias en reconstrucción de LCA (R-LCA) entre los traumatólogos ejerciendo en Chile, delineando sus preferencias en cuanto a la técnica quirúrgica.

Método encuesta online de selección múltiple y recolección anónima de datos, dirigida a todos aquellos cirujanos que realizan R-LCA en Chile. Fue enviada por correo electrónico desde la Sociedad Chilena de Ortopedia y Traumatología a todos sus afiliados.

Resultados 103 cirujanos completaron la encuesta, realizando su práctica quirúrgica en Santiago (53%) y regiones (47%). En el 53% de los encuestados la cirugía de rodilla representaba más del 75% de su práctica, mientras que sólo en 9 ellas eran menos del 25%. El autoinjerto de isquiotibiales es utilizado en el 70% de R-LCA, seguido por el autoinjerto de tendón patelar (27%). En cuanto a la preparación de túneles, 33% utiliza técnica transtibial y 67% túneles independientes (13% fresado retrógrado, 54% portal medial). Para la fijación de injerto isquiotibiales, botones corticales es lo más utilizado en el fémur (73%), y tornillos interferenciales en la tibia (82%). Para la fijación femoral y tibial de injerto de tendón patelar, los tornillos metálicos son los más utilizados (75%). Un 41% realiza un pretensado del injerto, un 59% lo ciclan una vez fijo, y sólo 8 aplican una solución antibiótica sobre el injerto. La mayoría (89%) realiza la fijación en 10°-20° de flexión, ya sea con rotación externa (36%) o neutra (53%). En un 7% de las R-LCA primarias y en un 27% de las revisiones agregan una reconstrucción anterolateral.

Conclusión la tendencia en R-LCA en Chile es el uso de autoinjerto de isquiotibiales, con fresado independiente del túnel femoral y fijación en flexión con botones corticales y tornillos interferenciales.

Abstract

Objective To describe the trends in anterior cruciate ligament reconstruction (ACL-R) among Orthopaedic surgeons working in Chile, outlining their preferences regarding surgical technique.

Method An online, multiple choice, anonymous survey was sent via email from the Chilean Orthopaedic and Trauma Society to all its members, with instructions to be completed by surgeons who perform ACL-R.

Results 103 surgeons completed the survey from Santiago (53%) and other regions (47%). For 53% of the surgeons, knee surgeries represented more than 75% of their practice, and in only 9 cases it was less than 25% of it. The autologous hamstring tendon graft was in 70% of the ACL-R, while patellar tendon graft in 27%. For tunnel drilling, 33% of surgeons use transtibial technique, and 67% prefer independent tunnel drilling (13% retrodrill, 54% medial portal). Fixation method for hamstring tendon graft is mostly with cortical buttons on femur (73%), and interference screws for the tibia (82%). Patellar graft was fixed with metal screws (75%) in both femur and tibia. 41% of surgeons pretensed the graft, 59% cycle it once, and only 8 coated the graft with antibiotic solutions. Most (89%) fixate de graft in 10°-20° of knee flexion, with either external rotation (36%) or neutral (53%). Antero-lateral reconstruction is used in 7% of primary ACL-R and in 27% of revision surgeries.

Conclusion the chilean tendency for ACL-R is to use an autologous hamstring tendon graft, with independent drilling technique, and fixation with cortical buttons and interference screws for femur and tibia respectively.

Palabras clave

ligamento cruzado anterior - reconstrucción - selección de injerto - encuesta

Keywords

anterior cruciate ligament - reconstruction - graft choice - survey

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