us present our data. I also want to thank the co-authors in the study for this. They did the lion's share of the work, no disclosures for this. So we all know that ACL tears are very common in the United States and around the world and that a lot of work has been done to study these injuries. But the real question is how are we really doing at this point in 2023? If we look at the literature and we look at some of the data from the Moon Group, we're doing pretty good with a four and a half percent re-tear rate. But if we look at a subset of patients who are high risk, such as females in age 15 to 20 years old, that re-tear rate actually goes up pretty significantly. If we look at return to sport, we're not doing as well as we thought. Typically in the literature we show that about an 81% return to rate, return to sport at any level has been found. But if we're looking at patients returning to their pre-injury levels, we're only looking about a 65 to 70% return to play. Another concerning issue is the fact that between 25 to 40% of patients who undergo ACL reconstruction have been found to have continued rotational instability of their knee after surgery. So how are we really doing? Well 60% of the time it works every time, so that's something we can take in. So when we're trying to figure out what's going on with our ACL reconstructions, one of the issues is that anterolateral complex that has become very popular. Freddy and his group looked at ACL tears and found that 90% of patients undergoing ACL reconstruction had injuries to their anterolateral complex. So to deal with this, many surgeons are starting to add extra articular tenodesis or anterolateral ligament reconstruction to their surgeries. Al Getgood and his group found that by adding a lateral extra articular tenodesis to his high-risk patients undergoing hamstring autographs, he was able to reduce the clinical failure rate from 40% down to about 25% and concluded that by adding an LET to their hamstring autographs in these high-risk patients, that they could find a 60% risk reduction in graft failure. Other studies have also shown that adding an LET or ALL to their ACL reconstructions have reduced three-fold the graft failures. But lateral extra articular tenodesis and these other extra articular procedures are not without complications. Hematoma, painful hardware, and even possibly over constraining the lateral compartment leading to early arthritis are possibilities. So is there a different way to stabilize these knees? The quadriceps autograft has become a very popular graft for many people and is gaining a lot of traction due to its good clinical outcomes and excellent biomechanical properties. So we asked the question, if we do a quad autograft by itself without an LET, will this decrease the clinical failure rate similar to that of a hamstring autograft with LET? We did a retrospective study of patients undergoing ACL reconstruction. These are high-risk patients with either a pivot shift of two or greater or those with general ligament dyslaxia. We broke them into three groups, either hamstring autograft, hamstring autograft with LET, or quad autograft. And we looked at the outcomes of clinical failure, which included residual pivot shift or a graft tear, along with a return to sport and complications. The patient population for these three groups was pretty homogeneous with the exception that the quad autograft group did have a significantly larger diameter of graft. Overall, we did find that the LET and quad autograft group did decrease the clinical failure rate at two years compared to hamstring alone. And there was very little difference between the LET and quad autograft group. Looking specifically at graft re-tears, we again found that the LET and quad autograft group did decrease the rate of graft tearing compared to the hamstring alone. And again, there was minimal difference between the LET and the quad autograft group. Looking at residual pivot shift, we did see that the LET and quad, again, were able to reduce the residual pivot shift, and that there is a minimal difference between the LET and quad autograft. But the quad autograft did start to trend towards having a higher pivot shift rate, but it did not reach statistical significance. Looking at return to sport, the three graft choices seemed to return people to sport at similar rates and at the same or higher levels. But we did find that the addition of a quad autograft did lead to a faster return to play at seven and a half months compared to about nine and a half months with the hamstring autograft group. Looking at complications, we found that there is no difference between the three groups with regards to complications. And looking at LET-specific complications, only a small percentage of patients developed hematomas. So in summary, we found that the all-tissue quad autograft was equivalent to the hamstring autograft and LET in high-risk patients. We also found that the quad autograft was able to reduce a residual pivot shift similar to that of the LET with hamstring autograft, but would these hold up at bigger numbers of patients? We're not sure. LET addition did not lead to a lower return to rate, and that the quad autograft was able to return athletes back to sport at a shorter time period. Thank you.

ACL tear management

re-tear rate

return to sport rate

rotational instability

graft failure rates