When I Add Additional Procedures

Description

In a recent expert panel discussion led by Lee Kaplan, Dr. David Altchek explored the nuances of ACL reconstruction procedures, particularly in younger patients and the rising popularity of additional surgical techniques. Kaplan introduced Altchek, highlighting his different perspectives, particularly concerning the evolving inquiries from families in sports contexts.



Dr. Altchek noted a significant increase in ACL repair awareness due to social media, which influences how young athletes and their parents approach treatment options. He emphasized the importance of patient education and adapting to the changing landscape of surgical techniques, including the longstanding preference for bone-tendon-bone (BTB) grafts as the standard for ACL reconstructions.



Despite BTB being the gold standard, Altchek acknowledged the growing traction of quadriceps tendon grafts, especially in younger patients with open growth plates. The expert further elaborated on the use of extra-articular procedures, like Lemaire tenodesis, which can help address persistent anterolateral laxity after isolated ACL reconstructions, particularly in high-risk populations like young athletes returning to high-velocity sports.



The conversation also addressed the complexities of graft selection in patients with hypermobility syndromes, such as Ehlers-Danlos, where greater stability might be needed. Altchek recommended the use of BTB grafts in such cases, correlating the patient's age and other presenting conditions with optimal surgical outcomes.



Panelists concluded with insights on modern approaches to ACL surgery, the controversy surrounding additional procedures, and the future directions of rehabilitation and surgical practices concerning ACL injuries.

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