172: ACL 2.0: Playbook for Reducing Retear Risk

Live from the Arthrex Team Physician Controversies ConferenceIn this episode of The Sports Docs Podcast, Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leading ACL experts—Dr. Pat Smith and Dr. Aaron Krych—to discuss strategies to reduce failure after ACL reconstruction.The conversation highlights the evolution of ACL surgery, focusing on graft selection, fixation, biologic augmentation, and mechanical protection, with an emphasis on optimizing outcomes in young, high-risk athletes.Graft: Autograft vs AllograftStrong evidence shows higher failure rates with allograft in young athletes MOON data: ~4–6x increased risk of failure in patients <25 years Allograft best for: Older, lower-demand patients  Revision or multi-ligament cases Autograft SelectionGraft choice depends on: Age, sex, sport, and anatomy BTB: Preferred for high-level pivoting athletes  Strong fixation, less graft elongation Quadriceps tendon: Increasingly utilized  Larger graft diameter  Less donor-site morbidity vs BTB  Particularly useful in younger and female athletes Key insight: Grafts <8 mm are associated with higher failure riskInternal Brace (IB)Indications: Young athletes  Hyperlax patients  Revision ACL Benefits: Decreased graft elongation and cyclic displacement  Reduced postoperative laxity  Lower rerupture rates (~1% at 5 years in some studies)  Faster return to sport and improved rehab confidence Lateral Extra-Articular Tenodesis (LET)Strong evidence supports reduced failure rates: Primary ACLR: ~11% → 4% (high-risk patients)  Revision ACLR: ~21% → 5% Benefits: Decreased pivot shift  Improved return to pre-injury sport  Cost-effective in high-risk populations Indications for LET Age ≤25 years  High-grade pivot shift  Knee hyperextension  Return to cutting/pivoting sports  Revision ACL reconstruction LET Surgical Technique PearlsIT band graft (7–8 cm x 1 cm) Passed under or near LCL depending on technique Fixation near lateral epicondylePearls: Fix in neutral rotation and ~30–60° flexion  Avoid overconstraint  Close IT band defect Featured GuestsDr. Pat Smith – Hospital for Special Surgery NaplesDr. Aaron Krych – Mayo Clinic, Team Physician for the Minnesota TimberwolvesStay ConnectedApple PodcastsSpotifyYouTubeFollow us on Instagram for more insights on cutting-edge sports medicine, athlete recovery, and performancehttps://www.instagram.com/thesportsdocspod/Our Hosts:Catherine Logan, MD, MBAhttps://www.cloganmd.com/Ashley Bassett, MDhttps://orthopedicnj.com/physicians/ashley-bassettwww.thesportsdocspod.com