ACL tears are a common injury and being seen with greater frequency and at younger ages. Tears lead to loss of time from sport and activities and can lead to further joint deterioration without prompt recognition and treatment. The standard treatment is a reconstruction with autograft (patients tissue) or allograft (donor, cadaveric tissue). The choice of graft depends on several factors including age of patient and sports activity level. Currently, the time to return to sport has been shown to effect re-injury rates. Historically, 6 months after surgical reconstruction was considered an appropriate time to return to sports without restrictions. This notion has been challenged by recent studies noting lower re-injury rates by waiting 9 months or more to return to sports.
Newer surgical instruments and a retrospective look at studies from decades ago regarding primary repair have lead to resurgence in interest in primary repair instead of reconstruction. Failure rates have been high with this technique in previous studies that lead to the abandonment of this procedure. However, when evaluating the results or success of repair in specific tears, the results can approach that of a reconstruction. Specifically, proximal tears (from the femur) have better success when repaired. The advantage of a repair is that the ACL can be saved, less invasiveness and potentially faster return to sports. If the repair were to fail the standard options for reconstruction still exist. This is particularly attractive in pediatric patients where reconstruction techniques can injure growth plates.
Not every patient is a candidate but the option should be available for those patients inclined to have a repair over a reconstruction. I offer this to my patients who are appropriate candidates based on MRI appearance and surgical evaluation. Below is a short video demonstrating a repair I performed and the technique utilized.
Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.
Anterior cruciate ligament tears are one the most common serious sports knee injuries that lead to prolonged time out from sports participation. It is estimated that approximately 100-200,000 ACL tears occur per year. The incidence of ACL tears has risen over the years due to increasing sports participation, training and the number of games athlete’s are playing. A concerning statistic is that the rate of tears in pediatric age athletes has increased over the last 20 years.
The ACL is an important ligament that provide stability to the knee particularly with pivoting and cutting movements that are common in sports. It is the primary restraint to anterior translation of the tibia on the femur, but also provides significant rotational stability to the knee. Most injuries to the ACL are non contact and occur with rapid direction changes, deceleration and landing from a jump. It is common for the athlete to feel a pop, immediate pain and develop swelling over the first 24 hours.
ACL reconstruction is the usual recommendation to treat an active person with an ACL tear. This is generally performed through an arthroscopic assisted procedure. One of the major considerations is which type of graft to use. In general, graft options include autograft ( the patient’s own tissue) and allograft ( a cadaveric donor tissue). Common autograft options include the patellar tendon, hamstring tendons and quadriceps tendon. Allograft options include the same plus different soft tissue grafts from other areas. Choosing the best graft for each patient depends upon the age of the patient, activity level and a variety of anatomical factors. I utilize all types of graft options in my practice and base the choice of the graft on multiple factors and discussions with my patients.
Within the autograft choices, each has its pro and cons. The patellar tendon graft is considered the gold standard, but the other graft choices may be a better option in select patients. Patient size, type of sport, age (growth plates still open) and history of other knee complaints in the past are important considerations when choosing a graft.
It is generally accepted that autografts have a lower re-tear rate than allograft in younger patients, highly active patients and patients participating in competitive sports. Allograft reconstructions have a similar success rate in patients that are older (generally 35 year-old and up) and do not participate in highly competitive sports on a frequent basis. The research continues to define which grafts have the best success in different patients and new information continues to guide our decision making.