A Nationwide Profile of ACL Reconstruction in Brazil: Graft Choice, Extra-articular Procedures, and Meniscal Management

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is one of the most commonly performed procedures in sports medicine. Although international surveys have described global trends in graft selection, extra-articular procedures, and meniscal management, contemporary nationwide data from Brazil remain limited. Hypothesis/Purpose: To characterize current ACLR practices among Brazilian knee surgeons, including graft choice, use of lateral extra-articular procedures, meniscal management, and return-to-sport (RTS) strategies. We hypothesized that Brazilian surgeons would adhere to contemporary evidence regarding meniscal preservation and RTS timing, with distinctive patterns in graft selection and extra-articular augmentation. Study Design: Cross-sectional study. Methods: A nationwide, web-based survey was distributed to board-certified orthopaedic surgeons performing ACLR. The questionnaire included 60 items addressing surgeon characteristics, surgical technique, graft selection, use of lateral extra-articular procedures, meniscal management, and RTS criteria. Responses were analyzed descriptively, with exploratory association analyses evaluating relationships between surgeon characteristics (age, region, and surgical volume) and selected surgical practices. Results: Of 1545 invited surgeons, 382 completed the survey. Hamstring tendon autografts were the primary graft choice for 90.1% of respondents, followed by bone-patellar tendon-bone autografts (5.8%). Lateral extra-articular procedures were used at least occasionally by 94.5% of surgeons in primary ACLR and frequently or always by 74.6% in revision cases. Increased rates of meniscal repair were reported by 82.2% of respondents, and unrestricted RTS was most commonly authorized between 9 and 12 months (74.1%). Higher surgical volume was associated with more frequent use of lateral extra-articular procedures in primary (P = .001) and revision settings (P = .046), as well as increased meniscal repair rates (P = .016). Regional and age-related differences in lateral extra-articular tenodesis/anterolateral ligament use were also observed. Conclusion: Brazilian ACLR practices appear broadly consistent with contemporary international trends, particularly regarding meniscal preservation and RTS timing. Distinctive features include a predominant preference for hamstring autografts and a high rate of lateral extra-articular procedure use. Surgeon characteristics were associated with variation in selected surgical practices.