Autogenous Patellar Tendon Graft for ACL’s

The autogenous patellar tendon graft is the gold standard for anterior cruciate ligament (ACL) reconstruction of the knee.  Two new studies just published in the prestigious American Journal of Sports Medicine have confirmed that the autogenous (the patient’s own) patellar tendon graft is superior to the autogenous hamstring graft. The results were quite dramatic as patients with hamstring tendon grafts had TWICE the risk of revision compared with patients with patellar tendon grafts!! Younger age was the most important risk factor for revision, and no effect was seen for sex.

We routinely recommend the autogenous patellar tendon graft in competitive athletes 40 years of age and younger. The procedure is difficult to do and that is why other orthopaedic surgeons do not perform it BUT the results are superior to any other ACL reconstructive procedure.

Please call us if you have any questions about ACL reconstruction and which procedure would be best for you!

Keep Moving!

Dr. Sisto

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ACL Tears – Autografts vs. Allografts

Tears of the anterior cruciate ligament of the knee are devastating injuries and, unfortunately, are on the rise in incidence. There are many factors to explain this but the increase is primarily among female athletes.
The treatment of a torn ACL is surgical in young patients and in older athletes who do not want to stop competing and enjoying sports.
Two recent events have occurred which verifies that the surgical procedures done by the surgeons at The Los Angeles Orthopaedic Institute are the BEST to reconstruct the ACL.
Two long term studies have just verified that allografts are inferior compared to autografts to reconstruct a torn ACL. Allografts are tissue from a cadaver (dead body) and an autograft is from the patients’ own body. The advantages of an allograft are smaller incisions and less pain in the first week post-operatively. The disadvantage, however, is a higher FAILURE rate which is unacceptable.
We have always known that autografts are superior and we have ALWAYS recommended autografts to our athletes!
The choice of autografts is either the patients’ patellar tendon or the hamstrings. We have always preferred the patellar tendon for THREE main reasons.
#1 – The patellar tendon has bone on either side and we get bone to bone healing which is the quickest and strongest graft!
#2 –  The patellar tendon is the strongest graft!
#3 –  We do not want to sacrifice the hamstring tendons as this leads to knee weakness and stress on the reconstructed knee.
Adrian Peterson, the elite running back for the Minnesota Vikings just returned from ACL surgery and had his best running year ever. Of course he had a patellar tendon autograft which is what we have been performing in our patients over the past twenty years.
The Los Angeles Orthopaedic Institute surgeons are the orthopaedic surgeons for Calstate Northridge (CSUN) which are the only Level I Scholarship Athletes in all of the San Fernando, Santa Clarita and Antelope Valleys. The most elite athletes, coaches and trainers have selected us to perform these surgeries on their athletes for over 15 years!
We hope you maintain healthy knees but if you or a friend tears the ACL we should be your FIRST CHOICE!

Stay Healthy,
Dr. Sisto

ACL Tears

Mariano Rivera, the star pitcher of the Yankees, and Derrick Rose, the top point guard in the NBA, both recently tore the Anterior Cruciate Ligament (ACL) which is the main stabilizing ligament of the knee. Their notoriety has thrust the importance of the ACL into the national headlines but for thousands of athletes all over the country an ACL tear is a common and serious injury to their own knees.
We are the Team Physicians for Cal State Northridge (CSUN), Antelope Valley and Mission Community Colleges. In addition, Chaminade and Milken High Schools as well as the Lancaster Jet Hawks which is the Single A affiliate of the Houston Astros professional baseball team. We have taken care of many high school athletes with torn ACL’s and we recognize the magnitude of the injury and the program which is required to overcome the surgery and return to the same level of athletic performance.
ACL injury is extremely common with more than 100,000 ACL reconstructions performed annually in the United States. The majority of the ACL injuries occur in athletes but work and auto accidents also are common. Associated injuries include meniscus tears (the shock absorber of the knee) and bone contusions.
An untreated ACL tear will lead to an unstable knee and there is an increased incidence of additional injury to the knee if surgery is avoided. Patients who participate in aggressive cutting and pivoting sports, such as basketball, soccer, volleyball, lacrosse and tennis have a high rate of recurrent instability without ACL reconstruction. In view if this, athletic patients who choose to return to these sports generally undergo surgery soon after the injury.
The technique for ACL reconstruction involves placing a free tendon graft in the anatomic position of the ACL. The tendon graft can be taken from the patient’s injured knee or from a donor. All graft choices have advantages and disadvantages.
We perform over 200 ACL reconstructions each year at our Sports Center at The Los Angeles Orthopaedic Institute. We take care of the most elite athletes in Southern California. If you have an ACL tear, please contact us for an in-depth discussion of which treatment option will be best for you to maximize your recovery and return to your highest level of athletic performance.
 

New ACL Technique

The anterior cruciate ligament (ACL) is the prime stabilizer of the knee to prevent anterior instability. Ligaments are the “ropes” of the knee which connect bone-to-bone and stabilize the knee. When ligaments tear the two ends spring apart like a “torn guitarstring” and the ligament loses its blood supply and it dissolves. The patient will have an unstable knee without an ACL which can lead to a meniscus tear and early degenerative arthritis of the knee.
The reconstruction of an ACL tear utilizing the patients own tendons  (structures which connect muscle to bone) or a allograft (cadaver donor) is a successful procedure but one that, unfortunately, does not prevent and may accelerate the development of early degenerative arthritis. The reason for this is that in the past we have used a Trans-Tibial technique to perform our drill holes in the bone to stabilize the ligament. This technique cannot put the ACL graft back to its “Anatomic Footprint Position” and will change the function (kinematics) of the knee which will lead to early arthritis.
A new technique has been devised to create our bone tunnels in the femur and tibia at the “Anatomic Footprint Position” which enhances stability and restores the normal kinematics of the knee and prevents the development of early arthritis.
We routinely use this new “Anatomic” ACL reconstruction and our results have been fantastic! If you have an ACL tear, ask your surgeon if they use the new “Anatomic reconstruction technique” and if they do not, get a second opinion with us to discuss the new technique and how it will improve the long-term outcome of you surgical result!

Keep moving!
Dr. Sisto