2022 Specialty Day Access Pass-Session I: Knee Ligament ACL

Video Transcription

Video Summary

This session, moderated by Drs. Dawes and Heemstra, presented cutting-edge insights on ACL injuries, particularly in female athletes and pediatric populations, alongside advancements in surgical repair and graft choices.<br /><br />Dr. Lynn Snyder-Mackler highlighted evidence-based knee injury prevention programs, emphasizing early implementation to reduce primary and secondary ACL injuries. Secondary prevention requires rigorous rehabilitation, patient education on re-injury risks, and compliance with progressive exercise protocols. Return to sport should not occur before 9-12 months, depending on age, and must meet strict functional criteria.<br /><br />Jennifer Beck addressed skeletally immature athletes with ACL tears, focusing on those with less than two years of growth remaining. She underscored the importance of growth assessment using knee bone age atlases and careful graft selection to avoid physeal damage. Soft tissue grafts are preferred, with limited evidence on growth disturbances, necessitating further research.<br /><br />Dr. Adam Anz discussed renewed interest in ACL repair augmented with synthetic scaffolds, reflecting on past complications with synthetic grafts but promising preclinical and early clinical results with braided polyethylene-polyester suture bracing. However, patient selection and longer-term data are critical.<br /><br />Dr. Martha Murray emphasized biologic augmentation in ACL repair using a sponge scaffold loaded with autologous blood to mimic healing environments similar to the medial collateral ligament. Early human trials showed comparable outcomes to reconstruction with possibly faster recovery and better hamstring strength preservation.<br /><br />A spirited graft debate followed: Dr. Jean Petskowski advocated for bone-patellar tendon-bone (BTB) and quadriceps tendon grafts in elite female athletes due to robust strength and lower re-rupture rates, citing hamstring graft limitations like smaller size and flexion weakness. In contrast, Dr. Liz Matzkin supported hamstring grafts, emphasizing proper quadrupling techniques to achieve ≥9 mm diameter grafts and minimal morbidity, which can equalize outcomes.<br /><br />Dr. Adnan Sethna presented data supporting lateral extra-articular procedures combined with hamstring grafts to reduce graft rupture rates, especially in high-risk athletes like skiers, challenging BTB as the gold standard.<br /><br />Dr. Michael Dodds discussed revision ACL surgery, stressing tunnel evaluation, two-stage approaches when necessary, slope-changing osteotomies to correct anatomy, and routine anterolateral augmentations to improve outcomes.<br /><br />The panel concluded with case discussions emphasizing individualized treatment strategies for combined ligament injuries, pediatric considerations, ACL repair candidacy, and realistic return-to-play timelines—highlighting the complexity of managing ACL injuries in female and young athletes and the evolving surgical and rehabilitative paradigms.

Asset Caption

Moderators: Julie A. Dodds, M.D., Laurie A. Hiemstra, M.D., Ph.D., F.R.C.S.

Keywords

ACL injuries

female athletes

pediatric ACL

knee injury prevention

rehabilitation protocols

skeletally immature athletes

growth assessment

ACL repair

synthetic scaffolds

biologic augmentation

graft selection