Management of knee injuries: Consensus-based indications from a large community of orthopaedic surgeons

Purpose: To describe preferences and to quantify the amount of agreement among orthopaedic surgeons regarding treatment options for four clinical scenarios of knee pathologies. Methods: A web-based survey was developed to investigate the attitudes of members of an international association of surgeons specialised in sports traumatology and knee surgery European Society of Sports Traumatology, Knee Surgery and Arthroscopy. Results: The response rate was 40 % (412 questionnaires). An inter-rater agreement score (the Normalised Chi-square based Agreement Nomogram, NX2A) was calculated for each question. For scenario 1, 56-year-old male, degenerative medial compartment on both the femoral and tibial side, the surgical approach was preferred to the conservative approach (p <0. 001). Biological procedures were not considered appropriate, and in this respect, the respondents achieved a moderate degree of agreement (NX2A = 0. 68). For scenario 2, 35-year-old male, early knee medial arthritis, the surgical treatment was preferred to conservative treatment (p <0. 001). The traditional closed-wedge tibial osteotomy was not regarded as an appropriate treatment with an excellent degree of agreement among surgeons (NX2A = 0. 76). For scenario 3, 46-year-old male, ACL lesion, there was an almost disagreement, as respondents showed no preference between a surgical and conservative approach (NX2A = 0. 005). Among surgical treatments, an almost perfect agreement with regard to the appropriateness of arthroscopic single-bundle ACL reconstruction with a semitendinosus/gracilis graft was reached by the surgeons (NX2A = 0. 8). For scenario 4, 69-year-old male, diffuse knee arthritis (all the compartments), an almost perfect agreement in favour of a total knee prosthesis was obtained for the management of this scenario (NX2A = 0. 85). Conclusions: Web-based survey can help orthopaedic surgeons discuss and propose indications for clinical practice in the management of some of the most common joint diseases. Level of evidence: Cross-sectional survey, Level V.