Suitability of the AAOS Appropriate Use Criteria for Surgical treatment of Anterior Cruciate Ligament Injuries

Aissam Elmhiregh, Mazhar Fuad, Ali Alrawi, Yousef Abuaudeh, Ali Al Mass, Mohamed Al Ateeq Aldosari, Ghalib Ahmed


Background: The Appropriate use criteria (AUC) was established by American Academy of Orthopedic surgeons (AAOS) to provide the appropriate treatment options to patients with anterior cruciate ligament (ACL) injuries.  This study aimed to assess the appropriateness of our current practice of surgical treatment of ACL injuries in comparison with appropriate use criteria recommendations.

Methods: A prospective data collection and analysis of adult patients undergoing ACL reconstructions from December 2018 until April 2019. 80 out of 87 patients were undertaken in this study. Demographic data and AUC variables were collected and input into the ACL appropriate use criteria website application to check the appropriateness of our treatments. The data of age, gender, activity level, presence of arthritis, presence of repairable meniscal tear and any history of appropriate non-operative measures were collected from the patient records.

Results: 80 patients were included in the study after excluding 7 patients who were consented and interviewed initially due to different reasons. Most of the patients were males 93.75% and 82.5% were aged above 25 years.Appropriate use criteria for anterior cruciate ligament injury treatment was applicable in our institution with 95% of our patients (76 patients) got appropriate treatment whilst the other 5% (4 patients) had their treatment categorized as maybe appropriate according to AAOS appropriate use criteria. No AUC rarely-appropriate treatment was encountered in our patients.

Conclusion: The appropriate use criteria for treatment of anterior cruciate ligament injuries is quite applicable and easy to perform clinically to guide treatment options of such injuries.




Anterior cruciate ligament, AAOS, Appropriate use criteria, ACL reconstruction.

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