APEX Knee Navigating Pearls and Pitfalls-ACL Graft Selection Debate 1: Patellar Tendon ACLR: BTB is the Gold Standard!

Video Transcription

Video Summary

In this video presentation on patella tendon ACL reconstruction, the speaker discusses the origins of ACL reconstruction and the optimal graft for the procedure. They mention the increasing incidence of ACL reconstruction, particularly in children and adolescents, possibly due to sports specialization. The speaker explains the technique developed in 1963 using the patella ligament and highlights the higher success rate but also the complications of this method. They discuss the current state of ACL reconstruction, including various graft choices and fixation techniques, with success rates of around 90%. The speaker also discusses the biomechanical properties, initial fixation stability, biologic incorporation, and graft morbidity of different graft options. They then move on to modern techniques, such as the use of an intermedial portal to decrease rotational knee laxity and various approaches for drilling femoral tunnels. Fixation options are also discussed, including internal brace augmentation. The speaker mentions the outcomes of ACL reconstruction, comparing hamstring tendon autografts and patellar tendon autografts, and the higher incidence of failure and revision with hamstring grafts. The presentation includes a study comparing quadriceps tendon and patellar tendon autografts, noting no difference in laxity but a higher incidence of pivot shift with the quadriceps tendon graft. Another study comparing BTB, quadriceps, and hamstring grafts found no difference in graft failure but greater laxity in the hamstring tendon group. The speaker explains why the BTB graft is considered the gold standard, highlighting its similar properties to the native ACL, lower laxity compared to hamstring and quadriceps grafts, and lower rupture rates. They also mention the disadvantages of the BTB graft, such as potential graft mismatch and donor site morbidity. The presentation concludes by thanking the Arthroscopy Association of North America for the opportunity to give the talk and stating no disclosures relevant to the presentation.

Asset Caption

Dr. Kelechi Okoroha

Keywords

ACL reconstruction

patellar tendon

graft options

fixation techniques

biomechanical properties