AANA25 Knee Access Pass-CONCURRENT SESSION 1F: Primary ACL Reconstruction in 2025

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Video Summary

In this comprehensive session on primary ACL reconstruction in 2025, experts addressed current controversies, diagnostic challenges, surgical techniques, graft choices, outcomes, and rehabilitation strategies. Dr. Aaron Critch emphasized the complexity of ACL injuries, noting no such thing as an isolated tear, and highlighted the importance of accurate diagnosis, risk factor identification (like posterior tibial slope), and tailoring graft choice to patient demands. Discussions underscored that malposition is a leading cause of graft failure, and while ACL reconstruction helps reduce post-traumatic osteoarthritis (PTOA), rates remain high.<br /><br />Dr. Adnan Saithna presented award-winning RCT data showing that combining ACL reconstruction with lateral extra-articular ligament (ALL) reconstruction using hamstring grafts significantly reduces graft rupture rates compared to isolated bone-patellar tendon-bone (BTB) grafts, especially in young, active patients. Subsequent consensus guidelines supported lateral extra-articular procedures in high-risk populations, including those with grade 3 pivot shifts, hyperextension, and revisions.<br /><br />Dr. Dave Flanagan advocated for meniscus repair alongside ACL reconstruction, highlighting its role in restoring knee stability and reducing PTOA long-term, despite some early rehabilitation challenges and reoperation risks if repairs fail.<br /><br />Dr. Eric Strauss reviewed common intraoperative pitfalls and corrective strategies in ACL surgery, emphasizing prevention techniques for graft harvest and tunnel drilling complications.<br /><br />Dr. Adam Onnes discussed biologic adjuncts (e.g., PRP, cell therapies) targeting graft incorporation and PTOA, noting current evidence is insufficient for routine use but highlighting ongoing research on autologous tissues and inflammation modulation.<br /><br />Dr. Catherine Logan underscored optimized post-op management, addressing bracing, quadriceps strength, blood flow restriction therapy, psychological readiness (e.g., GRIT, kinesiophobia), and biomechanical asymmetries. She stressed individualized, criterion-based rehab over time-based approaches to improve return-to-sport outcomes.<br /><br />Panel discussions emphasized holistic patient care considering physical and psychological factors, appropriate graft and lateral procedure selection, and tailored rehabilitation. A pediatric ACL case illustrated decision-making involving graft choice and meniscus repair. The session concluded with endorsement of the ANA ACL toolkit for ongoing surgeon education.

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Keywords

ACL reconstruction

primary ACL surgery

graft selection

posterior tibial slope

lateral extra-articular ligament reconstruction

hamstring grafts

bone-patellar tendon-bone graft

meniscus repair

post-traumatic osteoarthritis

intraoperative pitfalls

biologic adjuncts

postoperative rehabilitation

psychological readiness