2025 AANA/ASES Specialty Day All-Access Pass-AANA Session I: Knee, ACL

Video Transcription

Video Summary

The session featured a dynamic debate on ACL reconstruction graft options and repair techniques for a 24-year-old with a proximal ACL tear. Kevin Barnard argued that the patellar tendon (BPTB) remains the "gold standard" due to its lower revision rates and strong long-term outcomes, supported by registry data from Norway and the NFL that favor BPTB over hamstring and quadriceps tendon grafts. He emphasized morbidity concerns with revisions and the need for longer-term data on quad tendon grafts, though he supports adding lateral extra-articular tenodesis (LET) in select cases for improved stability.<br /><br />Catherine Logan highlighted the rising use of the quadriceps tendon graft, noting its biomechanical strength and lower donor site morbidity compared to BPTB, especially avoiding anterior knee pain. While quad tendon grafts may have a higher short-term learning curve and risk of quadriceps weakness, advances in surgical technique and rehabilitation (including blood flow restriction training) may improve outcomes. Psychological readiness to return to sport appears higher with quad grafts.<br /><br />Elizabeth Matzkin favored hamstring grafts for their minimal donor site morbidity, versatility in graft size, and easier recovery, endorsing the routine use of LET to reduce re-injury risk. <br /><br />Ben Yen presented ACL repair as an alternative for proximal tears, preserving native ligament tissue and proprioception. He argued repair is less invasive with minimal morbidity, though long-term failure data remain limited, and advised selective use depending on patient age and activity goals.<br /><br />Overall, the debate underscored that graft choice should be individualized, balancing biomechanical properties, morbidity, patient activity, and emerging evidence, with patellar tendon still widely regarded as the benchmark in high-demand athletes.

Asset Caption

Moderators: Jorge A. Chahla, M.D., Ph.D., Kelechi R. Okoroha, M.D.
Faculty: Kevin F. Bonner, M.D., FAANA, Catherine A. Logan, M.D., M.B.A., M.S.P.T., Elizabeth G. Matzkin, M.D., Yi-Meng Yen, M.D., Ph.D.

Keywords

ACL reconstruction

patellar tendon graft

quadriceps tendon graft

hamstring graft

lateral extra-articular tenodesis

ACL repair

graft morbidity