The 2018 Wexham Park Cruciate Ligament Meeting, featuring keynote speaker K. Donald Shelbourne, MD, highlighted the latest techniques to repair or reconstruct injured knees. Held in November in London, the meeting featured an international faculty and drew 250 knee surgeons and aspiring knee surgeons, along with physical therapists. Attendees came from Australia, Asia, United Arab Emirates, the United Kingdom and other countries in Europe, and the United States.
Dr. Shelbourne, an orthopedic surgeon at Shelbourne Knee Center, gave the keynote presentation, “35 Years of Experience In ACL Reconstruction,” and made six more presentations in five sessions during the two-day meeting. The presentations highlighted treatments used at Shelbourne Knee Center for ACL and other knee injuries. They were based on:
- More than 35 years of data from Shelbourne Knee Center’s research program, which includes data on more than 7,000 ACL surgeries
- Data from the literature
- Case examples
35 Years of Experience in 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 Dr. Shelbourne’s ACL reconstruction process include:
- Pre-operative rehabilitation (pre-op rehab)
- Use of a contralateral patellar tendon graft (PTG) 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.
Mechanism of Non-Contact ACL Injury
In the session on ACL Anatomy & Biomechanics, Dr. Shelbourne presented “Mechanism of Non-Contact ACL Injury.” He noted that non-contact ACL injuries occur most often:
- In competitive young athletes
- While in competition
- In knees with small ACLs
Dr. Shelbourne presented a proposed mechanism of non-contact ACL injury. When the mis-timed foot plant causes the tibia to shift forward enough to cause the lateral femoral condyle to come into uncontrolled contact with the posterolateral tibial plateau, the tibia is pushed further forward upon impact, tearing the ACL.
Graft Choice for ACL Reconstructions
In the session on Graft Choice, Dr. Shelbourne presented “Graft Choice for ACL Reconstructions: BPTB Is The Gold Standard.” He described the pros and cons of various grafts, and showed the superiority of patellar tendon grafts (PTGs) over other graft choices.
Read more about The Near-Invincible Graft for ACL Reconstruction.
Meniscus and Cartilage Injuries
In the session on Meniscus/Cartilage, Dr. Shelbourne made two presentations:
- “Treatment of Posterior Root Meniscus Tears in Patients with Osteoarthritis”
- “Long-term Results of Untreated Articular Cartilage Defects Found at Time of ACL Reconstruction”
Posterior root medial meniscus tears are dramatic and difficult to treat. Dr. Shelbourne highlighted rehab to improve ROM, leg control and function as the most effective treatment. Injections can be used to relieve pain and facilitate rehab.
Chondral defects are commonly seen during ACL reconstruction, however, they are generally asymptomatic. Dr. Shelbourne noted that most chondral defects do not require surgical treatment and proper non-operative rehabilitation can be effective. However, which chondral defects require surgery and when is unknown.
Natural History of Posterior Cruciate Ligament Injuries
In the session on Posterior Cruciate Ligament, Dr. Shelbourne presented “Natural History of PCL Injuries.” While opinions conflict on how to treat PCL injuries, it is likely that many of these patients will never have problems. Non-operative treatment used for PCL injuries can be applied to knees with multiple ligament injuries.
ACL Reconstruction in Skeletally Immature Patients
In the session on Paediatric ACL Reconstruction, Dr. Shelbourne presented “ACL Reconstruction in Skeletally Immature Patients.” As more youth participate in sports, ACL tears have increased. Shelbourne Research Center focuses on educating these patients and their parents on the importance of changing activities to prevent meniscus/articular cartilage damage.
When patients reach Tanner 3 or greater physical maturity, bone-patellar tendon-bone (BPTB) can be safely and successfully used. More than 80% of these patients return to basketball, football and soccer. Knee symmetry is re-established and maintained.
For more information about Shelbourne Knee Center research, call 888-FIX-KNEE.
References
- Shelbourne et al., Rehabilitation for Patients Following ACL Reconstruction: A Knee Symmetry Model. Sports Health, 2009.
Photo credit: John Skliros/Clockwork Medical