Proven, Predictable ACL Reconstruction

Athletes treated for ACL tears at Shelbourne Knee Center return to sport at a higher rate and faster than athletes treated elsewhere: 85–90% of Shelbourne Knee Center patients return to sport ⁽¹⁾, compared to a 50–60% average for most orthopedic practices In as little as 3 months after surgery, some Shelbourne Knee Center patients return to sport. On average, patients return to sport about 4–6 months after surgery ⁽²⁾, compared to 12 months or more elsewhere. ACL reconstruction patients treated at Shelbourne Knee Center also have a lower risk of arthritis in the future than most ACL patients ⁽³⁾.

A Proven Process with Predictable Results

The reason for these remarkable statistics is Shelbourne Knee Center’s proven and predictable ACL reconstruction process. Honed over 37 years and 7,000+ ACL reconstruction surgeries, that process includes use of the graft that research has shown to be best, precise surgical technique and pre- and post-op rehab with our own physical therapists and athletic trainers who specialize only in knees.

“Our technique is extremely reproducible and successful for establishing ACL stability,” says K. Donald Shelbourne, MD, orthopedic surgeon at Shelbourne Knee Center.

Using patient outcomes data from up to 30 years after surgery, Dr. Shelbourne and orthopedic surgeon Rodney Benner, MD, have learned what works best. They use research data to continually improve treatment for ACL tears.

The Near-Invincible ACL Graft

Dr. Shelbourne and Dr. Benner use the gold standard graft for ACL reconstruction: The patellar tendon graft (PTG). “PTGs have been proven to be by far the most durable, strongest, most predictable graft,” says Dr. Shelbourne. He and Dr. Benner use contralateral PTGs, which provide quicker return of range of motion (ROM)and strength and easier rehab.

Despite the clear benefits of PTGs, many orthopedic surgeons use hamstring or cadaver grafts. These grafts, however, take longer to heal and they have a higher rate of graft failure. Patients are required to wait much longer to try and return to sport than patients who receive a PTG.

“Young competitive athletes need the best possible procedure available. Hamstring and cadaver grafts have been shown to not be the best possible procedure,” says Dr. Shelbourne. Using a contralateral PTG allows for unrestricted rehabilitation and provides a predictable return to normal strength in both knees.

Precise and Proper Surgical Technique

Proper surgical technique for successful ACL reconstruction starts with arthroscopy followed by open surgery. At Shelbourne Knee Center, arthroscopy is used to examine the knee joint and repair any meniscal and/or bone surface damage. ACL reconstruction is performed through an incision in the knee.

Many orthopedic surgeons perform entirely arthroscopic ACL reconstruction. “This makes it difficult to get the overall picture of the knee and see where the new ligament goes,” says Dr. Shelbourne. “Most surgeons who do ACL surgery don’t have a reproducible, fool-proof way of putting the graft on the tibia and femur.” Guides from device companies are often anatomically incorrect.

Dr. Shelbourne developed his own anatomical guidelines for graft placement, backed by objective post-op documentation. Using the KT-1000 arthrometer, each patient’s ROM and knee stability are documented and compared to the non-graft knee. “This proves the success of the procedure,” says Dr. Shelbourne.

Superior Rehab Results

Although rehab is more complicated after ACL reconstruction with a contralateral PTG, Shelbourne Knee Center’s pre-op and post-up rehab protocols enable patients to achieve superior results. Before surgery, patients work with our physical therapists and athletic trainers to achieve:

• Full ROM
• Little or no swelling
• Normal walking 
• Appropriate strength and leg control.

The post-op accelerated rehab program eliminates swelling by having patients lay down with the knee above the heart for the first seven days ^(4,5). Therapy focuses on improving ROM before strengthening. By 2–3 months post-op, patients have nearly full extension and flexion:

• Full extension: 98% of patients
• Full flexion: 92% of patients ⁽⁶⁾.

For more information about ACL reconstruction at Shelbourne Knee Center, call 888-FIX-KNEE.

References

1. Shelbourne et al., Rehabilitation for Patients Following ACL Reconstruction: A Knee Symmetry Model. Sports Health, 2009.
2. Shelbourne KD, Urch SE. Primary anterior cruciate ligament reconstruction using the contralateral autogenous patellar tendon. Am J Sports Med. 2000;28:651-8
3. Shelbourne KD, Benner RW, Gray T. Results of Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autografts: Objective Factors Associated With the Development of Osteoarthritis at 20 to 33 Years After Surgery. Am J Sports Med, 2017 Oct;45(12):2730-2738.
4. Biggs A, Jenkins WL, Urch SE, Shelbourne KD. Rehabilitation for Patients Following ACL Reconstruction: A Knee Symmetry Model. N Am J Sports Phys Ther. 2009 Feb;4(1):2-12.
5. Shelbourne KD, Gray T. Principles of Anterior Cruciate Ligament Rehabilitation. In Prodromos CC (ed), Anterior Cruciate Ligament: Reconstruction and Basic Science, 2nd edition, Elsevier, Philadelphia, PA, 2017, p444-450.
6. Shelbourne KD, Beck MB, Gray T. Anterior Cruciate Ligament Reconstruction With Contralateral Autogenous Patellar Tendon Graft: Evaluation of Donor Site Strength and Subjective Results. Am J Sports Med. 2014;43:648-53.