With respect to graft choice, the most common options include:
short single tendon hamstring, 4 stranded hamstring and bone-patella
tendon-bone (the patient’s middle one third of patella
tendon and its bony attachments). Your surgeon will have his or
her own reasons for their graft choice as there is no perfect graft,
with each having their pros and cons. Whatever your surgeon’s
preference, with sound operative technique, appropriate graft
choice, and with modern function-based rehab, the vast majority
of patients can expect a good outcome and a successful return to
pre-injury activity.
With respect to long term consequences of ACL injury, certain
things are well known. The first of which is in an ACL injured
knee versus a normal knee there is an increased risk of developing
arthritis regardless of whether and ACL reconstruction is performed
or not. No study has been able to show that an ACL reconstruction
will prevent arthritis. However, studies have shown that an ACL
deficient knee is at an increased risk of further cartilage and
meniscal injury requiring surgery than on the ACL reconstructed
knee. It is known that these subsequent injuries increase the risk
of arthritis definitively. Furthermore, a significant increase in
the Tegner activity score (a standardised method of grading daily
activities and sporting activities) in ACL reconstructed patients
has been shown (3). In summary, whilst non-operative treatment
remains an option for some patients, most active patients will suffer
from the consequences of future episodes of instability and have
less optimal function if a reconstruction is not performed.
Dr Jason Beer is an Orthopaedic surgeon at Pindara
Private Hospital and specialises in sporting injuries,
knee surgery, joint preservation, paediatric knee
conditions, hip replacement and ankle surgery. Dr
Beer has worked in many major hospitals throughout
his career including the Princess Alexandra Hospital,
Royal Brisbane and Royal Children’s Hospitals, Mater
Adult’s and Mater Children’s Hospitals and Gold
Coast University Hospital.
Dr Beer has undertaken further sub-speciality
training in sporting injuries of the knee, knee
arthroplasty, arthroscopy, osteotomy and meniscal
transplantation. He currently holds the title of Senior
Lecturer in Orthopaedics at both Bond University
and Griffith University.
Single tendon short-graft ACL
reconstruction (Tape Locking System)
Dr Jason Beer
Pindara Specialist Suites | Suite 205, Level 2 | 29 Carrara Street | Benowa QLD 4217
P: (07) 5609 6682 | E: reception@drjasonbeer.com.au
1. Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L. &
Risberg, M. A. Simple decision rules can reduce reinjury risk by
84% after ACL reconstruction: the Delaware-Oslo ACL cohort
study. Br. J. Sports Med. Epub ahead of print (2016). doi:10.1136/
bjsports-2016-096031
2. Kyritsis, P., Bahr, R., Landreau, P., Miladi, R. & Witvrouw, E.
Likelihood of ACL graft rupture: not meeting six clinical discharge
criteria before return to sport is associated with a four times greater
risk of rupture. Br. J. Sports Med. bjsports-2015-095908 (2016).
3. Chalmers, Peter N. MD; Mall, Nathan A. MD; Moric, Mario MS;
Sherman, Seth L. MD; Paletta, George P. MD; Cole, Brian J. MD,
MBA; Bach, Bernard R. Jr. MD. Does ACL Reconstruction Alter
Natural History?: A Systematic Literature Review of Long-Term
Outcomes. JBJS: February 19th, 2014 - Volume 96 - Issue 4 - p
292–300
44 | Pindara Magazine ISSUE 13 | 2018