Every two years, experts in anterior cruciate ligament (ACL) treatment from around the world gather to share and discuss the latest science and clinical work during the international ACL Study Group meeting. At the January 2020 meeting in Austria, K. Donald Shelbourne, MD, an orthopedic surgeon at Shelbourne Knee Center, gave two presentations on the center’s innovative approach to ACL treatment:
- Results of ACL Reconstruction with Contralateral Patellar Tendon Autograft
- Thirty-five Years of ACL Reconstruction.
“We’ve been prospectively collecting data for 38 years and making changes to eliminate problems and allow most patients to achieve a successful outcome. I present these data so that other orthopedic surgeons know what we do and what it is possible to do,” says Dr. Shelbourne.
Shelbourne Knee Center’s research program tracks patient outcomes and studies factors related to those outcomes to determine how to improve treatment for knee problems. “Our data have enabled us to solve many problems in ACL treatment,” he says.
Held in Kitzbuhel, Austria, in January 2020, the meeting drew about 100 orthopedic surgeons. About half are based in the United States and the rest practice in Europe and other parts of the world.
ACL Reconstruction with Contralateral Patellar Tendon Autograft
Dr. Shelbourne has used the patellar tendon autograft (PTG) in more than 7,000 ACL reconstruction procedures. “The PTG is the most reliable graft for achieving stability. We feel using a PTG from the opposite knee gives patients the best chance of predictably getting back to normal,” he says.
The presentation covered results from 2,130 patients (60% male and 40% female), with a mean age at surgery of 23.6 + 9.6 years (range 12-65). Overall:
- 83% returned to sport
- 87% of young patients participating in high-risk sports returned to sport.
The mean time to fully return to sport was 5.6 + 2.3 months.
At a minimum of five years post-ACL reconstruction, objective follow-up on 671 patients showed:
- 95% had normal extension
- 93% had normal flexion
- 89% had both normal extension and flexion.
In follow-up on 1,277 patients at least five years post-surgery, patients reported:
- International Knee Documentation Committee Score:
- ACL Knee: Mean 85.2 + 15.9 points
- Cincinnati Knee Rating Score:
- ACL Knee: 89.1 + 13.2 points
- Graft Knee: 94.6 + 6.0 points.
Although rehab is more complicated with a contralateral PTG, pre-and post-op rehab protocols guided by Shelbourne Knee Center’s physical therapists enable patients to reliably restore ROM, strength and function after surgery, and to return to sports with good stability. The rehabilitation program is part of the center’s proven and predictable ACL reconstruction process.
Thirty-five Years of ACL Reconstruction
In “35 Years of Experience in ACL Reconstruction,” Dr. Shelbourne summarized lessons learned:
- ACL reconstruction isn’t just a surgery; it’s a process
- Surgery must predictably provide stability while still enabling patients to achieve and maintain normal range of motion (ROM)
- The graft must fit in the intercondylar notch in full extension
- The graft source must allow for rehabilitation and return to activities
- Preoperative and postoperative rehabilitation must minimize complications and allow full return of ROM, strength and function
Key components of Shelbourne Knee Center’s ACL reconstruction process include:
- Pre-operative rehabilitation
- Use of a contralateral patellar tendon graft for ACL reconstruction
- Accelerated ACL rehab protocol that prevents post-op swelling
This process has reliably enabled patients to obtain two normal knees and facilitated a return to sports rate of 85%,1 compared to a 50–60% average for most orthopedic practices.
Presentations and Publications
Dr. Shelbourne has been part of the ACL Study Group since it was founded in 1995. He makes frequent presentations there and at other local, national and international meetings.
In 2018, Dr. Shelbourne gave the keynote address and six other presentations at the Wexham Park Cruciate Ligament Meeting in London. That meeting drew 250 knee surgeons, aspiring knee surgeons, and physical therapists from many countries. Dr. Shelbourne has authored more than 150 journal articles and 40 book chapters.
Read more about Dr. Shelbourne.
For more information about at Shelbourne Knee Center’s treatment of ACL injuries and research program, call 888-FIX-KNEE.
References
1. Shelbourne et al., Rehabilitation for Patients Following ACL Reconstruction: A Knee Symmetry Model. Sports Health, 2009.