After the tear

BY: DR. NIRAV K. PANDYA    

   With high school sports season rounding into full swing, there will naturally be an increase in the number of ACL injuries in our clinic.

   One of the questions patients frequently ask is which type of ACL graft should be used for my surgery: bone-tendon-bone, hamstring, or cadaver? For many years, bone-tendon-bone (taking small pieces of bone from your knee cap & shin with a small strip of your patellar tendon) was the gold standard. The advantage is that for successful healing you were asking bone to heal to bone, which is quite predictable. The disadvantages include a larger incision, inability to use it in a growing child, knee cap fracture, and a higher incidence of anterior knee pain after surgery.

   As a result, many have turned to hamstring grafts (using two of the hamstring tendons in the back of your leg). The advantages include smaller incisions, no fracture risk, and less post-op pain. Healing is less predictable since you are asking soft tissue to heal to bone, and ham- string strength decreases.

   The final option is using tissue donated from a person who has passed away (cadaver). Although this technique decreases operating room time and speeds recovery (since you are not having to obtain your own tissue), recent studies examining their use in young children have been disappointing. A study in 2011 looking at more than 645 ACL surgeries found that in patients between the ages of 10 ““ 19, allograft tissue had a four times higher failure rate than using your own tissue.

   The ideal graft for a patient undergoing an ACL reconstruction should be a shared decision amongst the patient, family and physician based on the athlete’s needs and functional goals. 

   Dr. Nirav K. Pandya is a pediatric orthopedic surgeon specializing in pediatric sports injuries at the Children’s Hospital in Oakland. He sees patients and operates in Oakland and our facility at Walnut Creek.