male doctor examining female patient's bandaged knee

Improving Outcomes in ACL Reconstruction Surgery

Dr. Andrew Merritt

There is an incredibly important article this month in the January 2020 edition of the American Journal of Sports Medicine that evaluated outcomes after ACL reconstruction. Anterior Cruciate Ligament injuries in young, high risk, pivoting athletes continues to be a challenge with the chance of reinjury. This study aims to improve the outcomes after ACL reconstruction and is a study that will change how many surgeons address these complex problems.

As I often talk to my patients, ACL tears are a rotational injury, that is why they happen in cutting and pivoting sports, and often without any contact with another player. The twisting of the knee is what stresses the ACL and then subsequently causes a tear. As we try to get high-risk patients back to sports after treating an ACL tear, it is this rotational aspect of cutting and pivoting sports that leads to a higher rate of re-injury in younger athletic patients.

The highest risk patients are adolescent or young adult patients who wish to return to cutting and pivoting sports, and this has always been a challenging population in surgery. This article evaluates the results of doing a standard ACL reconstruction versus an ACL reconstruction with an additional ligament that helps to reduce this rotational instability in the knee.

We have all been waiting for this randomized clinical trial to prove in a head-to-head nature that adding extra rotational stability lowers the risk of a recurrent ACL tear. In this study, by adding the extra ligament on the outside aspect of the knee, they reduced the chance of a graft re-rupture from 11% with the standard technique of ACL reconstruction to 4% with the ACL reconstruction plus the additional rotational constraint. This is a relative risk reduction of 67%.

This study has been received very positively amongst orthopedic surgeons, as we are always working hard to try and prevent re-tears and re-injury after ACL reconstruction in high-risk patients. Over the last two years, this has become a common procedure in my clinic and now we have data from a randomized clinical trial that proves that this leads to a superior result in terms of re-tear of the graft. If you are experiencing an ACL tear and wishing to get back to cutting and pivoting sports or you have had a re-tear of your ACL, this would be clinically relevant to you. Please contact me if you would like an evaluation and we can discuss this study as well as how to improve the function of your knee and get you back to the activities that you love.

To read the abstract of the article - click here. To read a review of the January 2020 issue - click here.

Andrew Merritt, MD is an orthopedic surgeon specializing in sports injuries of the knee. He treats athletes of all ages and provides team coverage for many area high schools. For more information about ACL surgery, meniscectomy or knee injuries, please contact Proliance Orthopedic Associates at 425.656.5060 for a consultation.