Description
In this presentation, Sasha Carsen delves into the evolving topic of primary ACL (anterior cruciate ligament) repair, a controversial practice in orthopedic medicine. Carsen opens by highlighting the historical context, tracing ACL repair practices back to the late 19th century, with significant developments occurring in the 1960s through the 1980s. Despite its decline in popularity due to studies demonstrating minimal functional advantage over non-intervention, recent advancements in surgical techniques and tools are reigniting interest in ACL repairs.
A primary focus of the presentation is the importance of understanding different ACL tear types using classifications like the Sherman classification, which helps surgeons identify the characteristics of tears—be they avulsions or mid-substance tears—and tailor treatments accordingly. Carsen stresses the need for careful patient selection and the relevance of factors such as tear chronicity, tissue quality, and patient's activity levels when considering repair options.
Significantly, Carsen acknowledges that preoperative imaging is crucial in evaluating the integrity of the ligament and the nature of the tear, which directly influences surgical decisions. The use of advanced imaging techniques allows for more precise interventions. The presentation emphasizes procedural techniques for effective repairs, including the re-approximation of the ligament to the bone without additional grafts, minimizing donor site morbidity.
Patient rehabilitation is discussed, highlighting the lack of pain post-surgery as both a benefit and a challenge—patients often feel ready to return to activity sooner than advised. Carsen outlines criteria utilized for returning to sports, advocating for rigorous evaluation of strength and symmetry.
Lastly, Carsen addresses the limitations associated with current repair solutions, advocating that while ACL repairs can be successful, they remain a targeted tool rather than a universal remedy. There's excitement about the future of ACL repair, anticipating further improvements in techniques and outcomes over the next couple of decades.