Optimizing Outcomes Following ACL Reconstruction in 2025: A Case-Based Approach (2025 Annual Meeting)-Optimizing Outcomes Following ACL Reconstruction in 2025: A Case-Based Approach

Video Transcription

Video Summary

This panel discussion focuses on optimizing ACL reconstruction through a case-based approach, featuring four orthopedic sports medicine experts. Dr. Cassandra Lee advocates that bone-patellar tendon-bone (BTB) grafts remain the gold standard for ACL reconstruction, highlighting their reliable bone-to-bone healing, lower graft failure rates, and strong long-term outcomes, especially for high-level athletes. She notes, however, the risk of anterior knee pain and patellofemoral arthritis associated with BTB grafts.<br /><br />Dr. Mary O’Connell presents quadriceps tendon autograft as a strong, reliable, and reproducible option with less donor site morbidity than BTB or hamstring grafts. She emphasizes proper harvesting techniques and fixation methods, suggesting the quadriceps graft offers comparable functional outcomes and stability.<br /><br />Dr. Clay Nully discusses ACL reconstruction augmentation in high-risk patients, such as female volleyball players with hyperlaxity and prior ACL tears. He reviews augmentation techniques—anterolateral ligament reconstruction (ALL), lateral extra-articular tenodesis (LET), and internal suture tape reinforcement—that enhance knee stability, reduce graft failure, and share load without replacing the graft. He cites studies showing reduced re-tear rates with augmentation in revision and primary cases.<br /><br />Dr. Harris Sloan explores revision ACL reconstruction, underscoring the importance of autograft use over allograft for better outcomes. He supports combined approaches utilizing quadriceps grafts, suture tape augmentation, and lateral extra-articular procedures to minimize re-tear risk in complex revisions. He also notes the nuanced decision-making about postoperative bracing.<br /><br />Throughout the discussion, the panel stresses careful meniscal repair concurrent with ACL reconstruction, techniques to avoid complications like cyclops lesions, and individualized graft and augmentation choices based on patient factors. Audience questions highlight clinical pearls on graft harvesting, button fixation verification, and balancing augmentation with meniscal pathology. Overall, the experts advocate tailored strategies combining graft choice and augmentation techniques to optimize stability, reduce failure, and enhance athletic return post-ACL reconstruction.

Asset Caption

Mary K. Mulcahey, M.D., FAANA | Cassandra A. Lee, M.D. | Clayton W. Nuelle, M.D., FAANA | Harris S. Slone, M.D., FAANA

Keywords

ACL reconstruction

bone-patellar tendon-bone graft

quadriceps tendon autograft

graft failure rates

anterior knee pain

patellofemoral arthritis

anterolateral ligament reconstruction

lateral extra-articular tenodesis

internal suture tape reinforcement

revision ACL reconstruction

meniscal repair