Episode 1

ACL Rupture & Reconstruction

Listen to Episode:

Objectives:

After listening to this episode, we hope that you can:


  1. Describe the anatomy of the ACL including attachment and insertion.
  2. Describe clinical symptoms associated with ACL Tears.
  3. Describe the common mechanism of injury.
  4. Describe the treatment including graft choices.
  5. Understand why pediatric injuries may need to be treated differently.

Show Notes

Episode 1: ACL Repair & Reconstruction

Optimal management of ACL injuries requires more than selecting a surgical technique. Preoperative knee status, graft selection, and patient specific factors significantly influence outcomes following reconstruction.



The following section reviews timing of ACL reconstruction, graft options, and patient-specific considerations, focusing on practical principles commonly emphasized in clinical practice and the operating room.

Timing of ACL Reconstruction: Why “Prehab” Matters

ACL reconstruction is rarely an emergency.


Why Surgery Is Delayed

●      Acute inflammation increases risk of arthrofibrosis

●      Pre-op ROM strongly predicts post-op ROM

●      Quadriceps activation must be restored


Ideal Preoperative Criteria

●      Full knee extension

●      Minimal effusion

●      Good quadriceps control

●      Ability to perform straight leg raise


Operating on a stiff knee → higher risk of long-term stiffness.



Graft Choice

While all grafts can produce good outcomes, patient-specific and surgeon preference factors drive graft selection.



 “There is no perfect graft — only the right graft for the patient.”

Bone–Patellar Tendon–Bone (BTB) Hamstring Autograft Quadriceps Tendon Autograft
Advantages Lower graft elongation Lower failure rates in high-risk athletes Less anterior knee pain Smaller incision Growing popularity Thick, robust graft Lower anterior knee pain than BTB
Drawbacks Higher rates of: Anterior knee pain Kneeling discomfort Slightly higher failure rates in young athletes (though this is emerging evidence) Risk of overstuffing in smaller patients Potential quad weakness early in rehab
Extra Considerations Often favored in: Contact athletes Elite pivoting sports (ie: soccer) Avoided in patients with: Hamstring injuries Poor hamstring strength -


Paediatric ACL Injuries: Why They're Different

The Problem = Open Physes

  • Risk of growth disturbance
  • Leg-length discrepancy
  • Angular deformity

Solutions

  • Physeal-sparing techniques
  • All-epiphyseal tunnels
  • Intraoperative fluoroscopy - get the lead on!