There is so much information out there, and so many opinions about how best to fix the female athletes ACL. Here is the simplest way of thinking about an algorithm for replacing the ACL. We devise this using outcomes-based evidence.
1. Should the ACL be replaced with her own tissue, or a cadaver graft?
The younger the athlete is, the more likely it is that the athlete should have their ACL replaced with their own tissue (autograft, not allograft).
Why is this?
Athletes under the age of 20 have an unacceptably high failure rate when a cadaver, or allograft, tissue is used to replace the ACL.
2. Do we take the tissue from the front of the knee? Or from behind the knee?
The more loose-jointed, or hyper-lax, the athlete is, the higher risk of failure there is using tissue from behind the knee, most commonly known as a hamstring graft.
On the other hand, the more the athlete is involved in jumping and landing sports, the higher risk there is to develop patellar tendonitis when returning to their sport if tissue from the front of the knee is used.
The most common tissue used from the front of the knee is the patellar tendon.
3. So what do we do if she is loose-jointed and wants to keep playing jumping and landing sports?
This is our toughest problem for sure.
There is evidence that females with congenital hyper laxity do better with a quadriceps tendon graft and they don’t seem to develop the same level of tendonitis after this operation.
For more from Doctor Bill sterett, visit www.drsterett.com
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