ACL Tear Surgery FACE-OFF [Which is BEST for Patients?]

By dpope2020

January 17, 2025

ACL, acl exercises, acl graft, acl graft choice, acl graft choices, acl graft options, acl injury, acl reconstruction, acl reconstruction surgery, acl recovery, acl rehabilitation, acl surgery, acl surgery graft choices, acl surgery recovery, ACL tear, acl tear surgery, anterior cruciate ligament, anterior cruciate ligament injury, best acl graft, dan pope, fitness pain free, knee surgery, orthopedics, physical therapy, sports medicine, torn acl, torn acl surgery

ACL Tear Surgery FACE-OFF [Which is BEST for Patients?]

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In today's video we go over: ACL Tear Surgery FACE-OFF [Which is BEST for Patients? FPF Show Episode 158 

  • 0:00 Introduction
  • 3:24 What is ACL Reconstruction and what are the goals of the surgery?
  • 8:01 What are the graft choices for ACL-R? [Auto & allograft, patellar, quad, hamstring]
  • 11:47 Is the graft as strong as the native ACL? [Load to failure]
  • 17:33 How long does it take for the ACL-R graft to fully heal over time? [Ligamentization]
  • 24:31 Which graft type has the best patient reported outcome measure?
  • 26:07 Which graft types have the highest and lowest failure (and re-tear) rates?
  • 33:31 Which graft type results in the best quadriceps and hamstring strength over time?
  • 35:35 Which graft type has the best return to sport rate?
  • 41:29 Which graft type has most donor site morbidity (issues due to harvesting the graft) and complications?
  • 46:36 Quad tendon graft: ideal patient, pros and cons
  • 48:24 Bone patellar tendon bone graft: ideal patient, pros and cons
  • 49:41 Hamstring tendon graft: ideal patient, pros and cons
  • 52:16 Allograft: ideal patient, pros and cons
  • 54:05 What is a Lateral Extra-articular Tenodesis? Why would a surgeon use this procedure along with an ACL-R?
  • 57:08 Which patients are appropriate for the addition of a lateral extra-articular tenodesis?
  • 58:11 Can you repair the ACL ligament and is this a viable surgery?
  • 1:01:27 What is the bridge enhanced ACL repair [BEAR] procedure?
  • 1:05:54 BEAR procedure vs. ACL-R [outcomes, return to sport, re-injury rates]
  • 1:14:03 Surgery vs. Physical Therapy for ACL Tears? [Evidence Based Review]

Think I'll just amputate...

- Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

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Thank you!

Dan Pope DPT, OCS, CSCS

References: 

  1. Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for anterior cruciate ligament reconstruction - part I: anatomy, biomechanics, graft incorporation and fixation. J Exp Orthop. 2023 Apr 1;10(1):37. doi: 10.1186/s40634-023-00600-4. PMID: 37005974; PMCID: PMC10067784.

  2. Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, Musahl V. Current trends in graft choice for primary anterior cruciate ligament reconstruction - part II: In-vivo kinematics, patient reported outcomes, re-rupture rates, strength recovery, return to sports and complications. J Exp Orthop. 2023 Apr 4;10(1):40. doi: 10.1186/s40634-023-00601-3. PMID: 37014518; PMCID: PMC10073382.

  3. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients. Clin Orthop Relat Res. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. PMID: 28205075; PMCID: PMC5599382.

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  8. Beyer J, Jones R, Igo I, Furyes AR, Liu J, Sohn DH. Comparison of Graft Type and Fixation Method in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis Based on Randomized Control Studies. JBJS Rev. 2024 Apr 4;12(4). doi: 10.2106/JBJS.RVW.23.00222. PMID: 38574182.

  9. Jackson GR, Mameri ES, Tuthill T, Wessels M, Asif S, Sugrañes J, Batra AK, McCormick JR, Obioha OA, Kaplan DJ, Knapik DM, Verma NN, Chahla J. Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review. Orthop J Sports Med. 2023 Dec 21;11(12):23259671231199728. doi: 10.1177/23259671231199728. PMID: 38145223; PMCID: PMC10748908.

  10. Momaya A, Harris C, Hargreaves M. Why Your Patient May Need an ACL Reconstruction Plus Lateral Extra-Articular Tenodesis Procedure. Int J Sports Phys Ther. 2024 Mar 1;19(3):251-257. doi: 10.26603/001c.94015. PMID: 38439781; PMCID: PMC10909304.

  11. Green DW, Hidalgo Perea S, Brusalis CM, Chipman DE, Asaro LA, Cordasco FA. A Modified Lemaire Lateral Extra-articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: 2-Year Clinical Outcomes. Am J Sports Med. 2023;51(6):1441-1446. doi:10.1177/03635465231160681

  12. Nwachukwu, B. U., Patel, B. H., Lu, Y., Allen, A. A., & Williams, R. J. (2019). Anterior Cruciate Ligament Repair Outcomes: An Updated Systematic Review of Recent Literature. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 35(7), 2233–2247. doi:10.1016/j.arthro.2019.04.005 

  13. Gee MSM, Peterson CDR, Zhou ML, Bottoni CR. Anterior Cruciate Ligament Repair: Historical Perspective, Indications, Techniques, and Outcomes. J Am Acad Orthop Surg. 2020 Dec 1;28(23):963-971. doi: 10.5435/JAAOS-D-20-00077. PMID: 33962444.

  14. Hoogeslag RAG, Huis In 't Veld R, Brouwer RW, de Graaff F, Verdonschot N. Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Five-Year Results of a Randomized Controlled Clinical Trial. Am J Sports Med. 2022 Jun;50(7):1779-1787. doi: 10.1177/03635465221090527. Epub 2022 Apr 29. PMID: 35486517.

  15. Mansour J, Ghanimeh J, Ghoul A, Estephan M, Khoury A, Daher M. Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies. SICOT J. 2023;9:8. doi: 10.1051/sicotj/2023007. Epub 2023 Apr 13. PMID: 37042698; PMCID: PMC10092275.