What’s In My Bag with Gregory S. DiFelice, MD

Arthrex—June 14, 2014

ACL Preservation

Q: Dr. Gregory S. DiFelice, with your recent release of the technique manual, ACL Primary Repair, it seems that you are challenging the current treatment standard of reconstruction for ACL rupture. Do you think that arthroscopic ACL preservation will become the new standard of treatment?

A: Not at all. The procedure that I have described is an arthroscopic method of reattaching the ACL back to its native origin or insertion using suture anchors. It is really only applicable to avulsion or "peel off" type tears and will never become the standard of care for ACL tears, in general, since the majority of them are mid-substance tears that is not effective for this technique. However, it is a nice tool to have in your surgical toolbox.

Q: Isn’t there a lot of historic experience regarding ACL repair that led us to migrate our treatment towards reconstruction? Aren't you just repeating history here?

A: I would certainly like to think not. The historic treatment of ACL repair was done as an open procedure and the studies looking at outcomes were significantly limited by the techniques, and knowledge base of the time. Looking back, the studies had significant bias that limited the conclusions that could be drawn. The paper considered to be the landmark paper on ACL repair at the time, by Mark Sherman et al, was the only one to analyze subgroups, and suggested that proximal tears with excellent tissue quality had a much better chance of positive outcomes. This is the group that I have focused on.

Read the full interview at arthrex.com.


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