(Knee Surg Sports Traumatol Arthrosc, 2018). The two broad categories of tissue used for ACL reconstruction are autografts, or tissue from the patient’s knee, and allografts, or tissue from a cadaver. However, according to a study presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM) in San Diego, utilizing bone-patellar tendon-bone (BTB) autografts instead of quadrupled hamstring (HS) autografts may improve … Autografts for ACL surgery. Both my children have seen Dr. Burnham with great results. Ultimately, the outcome of her simple twisted knee was a torn her ACL and torn meniscus requiring surgery. Although the hamstrings tendon is the most commonly used, several studies have suggested that it might have a higher failure rate in high demand athletes. As recreational skiers, women are six times more likely to suffer an ACL tear than men. Decelerating with the center of gravity posterior and the knee more extended or more straight. P: 970-569-3240 This has been shown to be the most resistant to stress and the most robust decision for an athlete to get back into sport with a reduced risk of retear. He diagnosed the problem quickly and accurately. Jeremy M. Burnham, MD | Orthopaedic Surgery, Knee, & Sports Medicine Doctor | Baton Rouge, Louisiana, Anterolateral Ligament (ALL) and Anterolateral Complex, Pediatric & Adolescent Tibial Eminence Fracture, Visco – Synvisc, Euflexxa, Supartz, Orthovisc, Gelsyn, Jeremy Burnham, MD - Sports Medicine & Orthopedic Surgeon. We had a wonderful experience and I highly recommend him. The patella is the kneecap and this graft is taken from the same knee being operated on. Nonsurgical treatment consists of physical therapy to address muscle imbalances, knee bracing, and resuming low impact activities initially. Suite B105 Click here for a list of questions suggested to ask prior to surgery (courtesy of the American Academy of Orthopaedic Surgeons - AAOS). BPTB involves the patella bone, patellar tendon, and the tibial tubercle of the tibia (shin bone). Very positive experience at Bone and Joint Clinic in Baton Rouge. The benefits of a quad tendon graft for female athletes include: Patients go home the same day as surgery. However, if one were to then resume cutting and pivoting sports following an ACL tear, the knee will most likely give way, causing pain, swelling, and possibly further damage to the cartilage in the knee. ACL injury can have implications on the athlete’s sport longevity, as well as other long-term consequences, such as the development of future knee osteoarthritis. We recommend using patellar tendon (bone-patellar tendon-bone, or BTB) or quadriceps tendon grafts in most young, high demand athletes. Recommend highly. Studies have repeatedly demonstrated a higher retear rate with allografts, particularly in younger patients. Dr. Burnham's bedside manner is a rare find in this fast paced world of medicine. During your rehabilitation, your physical therapist will work on normalizing any muscle imbalances and working on restoring normal biomechanics, which will help prevent reinjury to the knee or injury to your other knee. Dr. Burnham performed my hip pin surgery and it all went extremely well. Purpose: The ideal graft material for pediatric anterior cruciate ligament (ACL) reconstruction is controversial with many options available. The graft gradually stretching out over time causing recurrent knee instability. The graft is the actual structure used to reconstruct the ACL and serve as your new ligament once integrated into your body. Mobile Directions, 1140 Edwards Village II Orthopedic surgeons have several factors to take into account when choosing the appropriate graft for ACL reconstruction in athletes, including which grafts works best for each patient. These same biomechanical differences are also likely increasing their injury rate.   acl, anterior cruciate ligament, aossm, btb graft, graft choice, hamstring graft, quad tendon graft. He will now be caring for my hip and knee in the future. Common areas to harvest this graft are the hamstrings, the patellar tendon, and the quadriceps tendon. His surgery and recovery has been perfect! Studies show that women are 3-8 times more likely to sustain an ACL injury compared to men. Use of a quadriceps tendon autograft has been widely used for nearly 10 years and the results have been excellent. He made my daughter feel comfortable and made sure to listen to both of our concerns prior to his diagnosis. ACL doctor Richard Cunningham, MD utilizes the quad tendon for most of his female ACL reconstruction patients. We are so grateful for you both! Best ACL Graft for Athletes. He said there would be significant pain. The biomechanical differences affecting a female athlete’s knee are: It is the combination of anatomy, biomechanics, and movement related to athletics that contributes to the higher rate of ACL injuries in female athletes. GREAT DOCTOR VERY CARING AND KNOWLEDGEABLE!! Female athletes are two to eight more times likely to injure their ACL than males, however utilizing one graft repair treatment method in females may be more beneficial than another. 108 South Frontage Road West P: 970-476-7220 The first goal is to decrease swelling and restore knee range of motion. The quad tendon is also frequently used for ACL reconstruction revision surgery in female athletes who have torn their ACL graft and need their surgery redone. Easy to talk to and will answer any questions of your care. Central one third of the quadriceps tendon, Higher incidence of permanent pain with kneeling following surgery, Higher incidence of pain in the front of the knee, Higher incidence of developing knee arthritis earlier in life in some studies, Although rare, a higher risk of a subsequent patella fracture, The tendon graft being smaller than the native ACL, especially in females of smaller stature, The graft gradually stretching out over time causing recurrent knee instability, A tendency to land from a jump with the knee in a valgus position. Considerations include a smaller diameter ACL, a more narrow bony notch in the femur in which the ACL sits, the fact that women tend to be more knock kneed in their alignment, altered landing mechanisms, and possibly hormonal effects on ligament laxity and strength. We have followed all his advice and are healing very well. Also, I had to make numerous visits to the Ochsner Clinic due to my injury and Dr. Burnham's team and the staff at Ochsner were always very professional and courteous. 1. yenwen / Getty Images. Dr. Burnham and Jerrica are AMAZING! In addition, use of a The tendon graft being smaller than the native ACL, especially in females of smaller stature. He and his staff could not have been more helpful and professional. The following graft … Results for Female ACL Graft Repair Methods Differ Among Younger Athletes, Say Researchers. Differences in quadriceps, hamstring, and gluteal strength such that the quad dominates. They are in a knee brace and on crutches for several weeks. Although there are many factors that determine the best graft choice for an individual patient, it is becoming increasingly clear that hamstring grafts are probably not the best options for most young, active athletes – especially female athletes. Surgeons have known for some time that allograft (graft from donors) has a higher failure rate than autograft (the patient’s own graft). We were referred to Dr. Burnham. [58] By 16 weeks, patients can start to jog. Timing is an issue. Female athletes are anywhere from two to nine times more likely to sustain a noncontact ACL injury, with the highest rate of incidence occurring in the 15- to 40-year-old age range. His staff is very friendly and upbeat, knowledgeable and thorough. This is the first time in months that I have felt myself. The research is mixed, but there is evidence that the failure rate of this autograft is better than that of the hamstring autograft. We know ACL tears are extremely common in female athletes, particularly those participating in basketball, gymnastics, and soccer. My 14 year old son originally went in to see Dr. Burnham very scared (he hadn't had an injury before) and he was instantly made to feel at ease. Allografts avoid donor-site morbidity, but have been associated with infection and … Decreased hamstring strength. Type of hobbies such as hiking, dancing, etc. There are an estimated 200,000 ACL injuries reported in the United States each year, many of which occur due to sports injuries. allograft (cadaver) and 2.) We published a research paper demonstrating that if hamstrings are used, they often need to be augmented with extra tendon from a cadaver. Female athletes are more likely to injure their anterior cruciate ligament (ACL) than male athletes – between 2 and 8 times more likely. Dr. Burnham was very helpful for my injury! Without hesitation, Dr. Burnham reassured my daughter, answered all of her questions, discussed the importance of the surgery, and allowed her plenty of time to decide on her options and date of the surgery. Dr. Burnham made sure I knew what was happening and what could happen. Young, female athletes should get the BPTB autograft. August 2017 –ACL injuries are common injury overall; however, young female athletes are far more likely than males to suffer a sprain or tear to their anterior cruciate ligament, which is vital to the knee’s stability, according to orthopaedic surgeon Kevin D. Plancher, MD, founder of Plancher Orthopaedics & Sports Medicine. He gave excellent post-op instructions and exercises. But luckily, we have tons of experience and evidence in this area. Everyone I was in contact with, from support staff to Dr. Burnham, was kind, friendly, competent, and generous with time and information. In this article, we discuss 6 key ACL graft options you need to understand before undergoing an ACL operation. I’ll start with a cadaver graft (although the reader did not mention it in this question) because it does seem to be increasing in popularity for ACL reconstructions in the United States. Some concerns with the use of a patellar tendon autograft for ACL reconstruction: Some concerns with the use of a hamstring tendon autograft for ACL reconstruction: Given this, a quad tendon autograft is a great option for female athletes requiring ACL reconstruction surgery. Patients can spin on a stationary bike as soon as they can get around on the pedals. You Already Have A History Of Patellar Tendonitis Or Patellar Tendon Issues. Most of us favor early reconstructions in children because you are at high risk for developing secondary injuries such as a … Orthopedic Surgery, Sports Medicine, & Knee Doctor | Board Certified, When young, active athletes tear their ACL (anterior cruciate ligament), it usually needs surgery. The gold standard of ACL reconstruction is using a patellar autograft. Female athletes are two to eight more times likely to injure their ACL than males, however utilizing one graft repair treatment method in females may be … The first choice when deciding on an ACL graft is choosing between an allograft (tendon from a donor) or autograft (tendon from the patient). Amazing doctor, amazing family man...treats patients with the highest level of care, compassion, and quality! Furthermore, reinjury to the ipsilateral or contralateral knee can occur in >20% of athletes. By 8 weeks from surgery, patients can be riding a bike outdoors on flat roads. The main autografts used are the patella tendon and hamstring tendons. The quadriceps tendon is the least studied autograft for ACL reconstruction, and although interest in its use seems to be increasing, only 1% of orthopaedic surgeons consider the quadriceps tendon for either primary ACL reconstruction or for revision surgery. By 12 weeks, patients can do light hiking. Modern technology allows the review of MRIs and other imaging modalities for patients that live out of town. Overall, using one’s own tissues for an ACL graft is the best option for the vast majority of patients. Definitely recommend. Unlike a patellar tendon autograft, no need to harvest sections of the bone from the patella and tibia along with the patellar tendon. You can read more about female ACL injuries in a book chapter we wrote about that topic. Really a national leader in sports medicine! I had a traumatic knee injury that he performed surgery on. Patella vs Hamstring ACL Reconstruction Graft Options September 14, 2016 by Dr. Chad Carter, Chiropractor The last thing any person especially an athlete wants to hear after a knee injury is that they have torn their Anterior Cruciate Ligament (ACL). I would highly recommend Dr. Burnham, my first visit was yesterday and the doctor and his staff were very friendly, professional, and informative..I had X-rays and Dr. Burnham thoroughly explained each one, I was impressed with the time he took and how much he cared about implementing a plan to help me. Bone-patellar tendon-bone autograft could be recommended as a superior graft to hamstring autograft for ACL reconstruction in patients with generalized joint laxity: 2- and 5-year follow-up study. SAN DIEGO, CA – Female athletes are two to eight more times likely to injure their ACL than males, however utilizing one graft repair treatment method in females may be more beneficial than another, according to researchers presenting their work today at the American Orthopaedic Society for Sports Medicine’s … Edwards, CO 81632 ACL injuries: 35% of all knee injuries sustained 25% incidence of previous knee surgery 8% of participants have a history of ACL injury ACL injury is #1 reason for receiving a medical failure grade Only 46% of players reporting an ACL injury played at least 1 game Bradley et al., Am J Orthop (2008) Brophy et al. Patients can bear weight on the knee immediately after surgery, but it may take 2-3 weeks to be able to walk without crutches and to discontinue the knee brace. Patellar Tendon Autograft This is the “gold-standard” for ACL reconstruction and has been used for over 40 years as a reliable, safe graft for ACL reconstruction. He answered all my questions satisfactorily and his entire staff were polite and professional. The question is why? We are 2 weeks post-op right now. Quadriceps Tendon Graft. Dr. Burnham was able to save us a trip by reading the x-ray, examining her knee thoroughly, and giving us a dreaded prognosis. Excellent outcomes have been demonstrated with the use of the quadriceps tendon for female athletes requiring ACL reconstruction. Dr. Burnham was very thorough and took the time to explain what he thought my root problem may be, why, and how he suggested we proceed with my care. Autografts are far more commonly used, especially when treating high-level athletes. I actually recall reading that the average NCAA women's soccer team has one ACL tear every year, and that typically, 1 in 50 female NCAA basketball players will blow out an ACL in a given season. Highly recommended! After much debate, we decided that we needed to see an orthopaedic specialist to be sure it was not anything serious. He spent a great amount of time explaining everything to me in a way that I understood everything. P: 970-668-3633 Dr. Jeremy M. Burnham, MD - Sports Medicine, Orthopedic Surgery, Knee Doctor. Choosing the Right ACL Graft for Young Female Athletes. There are several options available, but young athletes and their families need to be careful in their graft decision process. F: 970-668-5052 Dr Burnham is so personable. The female athlete will be able to return to full activity with good strength, improved biomechanics and the confidence that the recovery program has been accomplished to the best possible outcome. The research suggests that ACL graft types taken from your own body tissue have historically had the lowest retear rates amongst athletes returning to sport. I was referred to Dr. Burnham from my spine doc, Chambliss Harrod, MD and he turned out to be a way cool guy. At Children's Colorado, we also offer a third option, called the quadriceps tendon autograft (also called the quad-tendon graft for short). A patella tendon graft is likely the best graft for active contact athletes… but you would need to wait until your growth plates are closed. Biomechanical studies analyzing female versus male performance with similar tasks has shown that female athletes tend to subject their ACL to higher stresses. Thank you Dr. Burnham and Jerrica for everything! The most common options include patellar tendon, hamstring tendon, and donor tissue (allograft). The healing phase is long, but he does A+ work. New research published at AOSSM demonstrated a significantly higher re-tear rate using hamstring tendons compared to the gold standard (patellar tendon). Dr. Burnham was very thorough with his examination and diagnosis. ACL reconstruction can be done with several different graft choices. Takes his time with you and doesn't hurry to rush out of the room if you have questions. It can take 8 months to be able to return to cutting and pivoting sports such as soccer or skiing. The gluteal musculature is weaker contributing to the valgus position of the knee. The quad tendon is long and can accommodate various graft lengths, Minimally invasive incisions to the harvest site, Reduced incidence of anterior knee pain compared to a patellar tendon graft. Background: Female athletes are 2 to 8 times more prone to anterior cruciate ligament (ACL) rupture than males. For the female athlete contemplating ACL surgery, there are several considerations: These considerations along with a comprehensive orthopedic physical examination and imaging, to include xrays and an MRI, will help the female athlete decide if there is a need for ACL surgery. I would recommend his services to anyone. Posted by Sports Medicine Admin      I have already told our family and friends how wonderful our care has been. Vail, CO 81657 Increased Risk of Graft Failure after ACL Reconstruction in Young Female Athletes with Hamstring Grafts Mark V. Paterno, PhD, PT 1 , Staci Thomas, MS 2 , Timothy E. Hewett, PhD, FACSM 3 , Robert A. Magnussen, MD 4 , Laura What is the Best ACL Graft for Female Athletes? Patellar Tendon Graft. hamstrings are used, they often need to be augmented with extra tendon from a cadaver, female ACL injuries in a book chapter we wrote about that topic, COVID-19 Updates – Ortho & Sports Medicine Clinic (Coronavirus), Dr. Burnham Discusses Football Injury Research and Serves as Panelist at LOA 2020, Dr. Burnham in PIVOT Study Group with newly published ACL research, Ochsner to Provide Healthcare Services for 2020 College Football Championship, Ochsner Expands Louisiana Marathon Sponsorship for 2020. It was refreshing to know that we were placing my daughter in very caring surgeon hands. Each of these choices has advantages and disadvantages. I highly recommend Dr. Burnham. Use of hamstrings tendon can compromise dynamic stability in an ACL-reconstructed knee, and patellar tendon harvest can lead to anterior knee pain and numbness. Suite 180 Dr. Cunningham and other sports medicine surgeons that do a high volume of ACL surgery recommend autograft and not allograft. My daughter injured her ankle in cross country practice and we were able to get in the next day to see Dr. Burnham. We recommend using patellar tendon (bone-patellar tendon-bone, or BTB) or quadriceps tendon grafts in most young, high demand athletes. Autograft options for ACL reconstruction are utilizing the: Patellar tendon and hamstring tendon autografts have been utilized for several decades with very good results. I went to Dr. Burnham for issues I was having with my shoulders. An anterior cruciate ligament (ACL) tear, an injury of the knee, can be devastating to a young athlete. My daughter hurt her knee playing soccer. F: 970-479-9166 Given this, a quad tendon autograft is a great option for female athletes requiring ACL reconstruction surgery. There is so much information out there and so many opinions about how best to fix the female athletes ACL. Following an ACL tear, there is initially significant pain, swelling, and instability but with time, the knee pain and swelling usually resolves and the knee can feel nearly normal. Their sense of compassion and understanding is more than we have ever experienced. In the end he offered the best treatment for me. F: 970-569-3260 Physical therapy is started the day after surgery with patients then going 2-3 times per week for several months. Dr. Burnham was very personable and explained my situation in great detail. A second opinion provides a thorough, unbiased, and honest assessment of a patient's medical condition. Broadly, there are two categories of graft: 1.) Read more here…. Research has shown that female athletes are two to ten times more likely than males to tear their ACL, yet over 70% of all ACL injuries are non-contact injuries that may be prevented. Everyone made us feel comfortable, and they were all polite and professional. I highly recommend him. This statistic includes everything from snowboarding to basketball, volleyball, field hockey and soccer players. He has a great rapport with teenagers. Mobile Directions, Best ACL Graft for a Professional Athlete. autograft (patient’s own tissue). He was outstanding. Weakness and tightness of the hamstrings places higher stresses on the ACL. The most common choices available are: Patellar tendon autograft Hamstring autograft Quadriceps tendon autograft Patella tendon allograft Certain graft choices may not be the best for younger patients. I am a coach, and I have two boys playing sports, the best thing I can say is that my sons will go see Dr. Burnham in the event they are injured, and I will always recommend him to my athletes. This involves harvesting a piece of bone from the patella (kneecap), the central 1cm of the patellar tendon, and a piece of bone from the tibia to create the new ACL. Mobile Directions, 360 Peak One Drive • Young, female athletes considering an ACLR with a HS graft after ACL injury should consider the elevated risk of graft failure and potentially pursue a more conservative post-operative course of care • Young female athletes who elect to undergo ACLR with a BTB autograft are at elevated risk of contralateral ACL injury and should Anterior cruciate ligament (ACL) injuries are on the rise at all levels of sport, including elite athletics. Med Sci Sports Exerc (2008) While MRI review does not replace a thorough history and physical examination, it can provide a valuable service when a face to face evaluation is not possible. If you're an athlete needing a doctor that understands; this is the guy. Because of these factors, ACL surgeon Richard Cunningham, MD utilizes the quadriceps tendon autograft option for the majority of the professional athletes he treats. Finally, many female athletes are more prone to knee cap pain in general and following a patellar tendon graft, the chances of having knee cap pain may be increased. I highly recommend him. Younger female athletes who wish to resume high level cutting and pivoting sports often require surgery. Female athletes are at the highest risk for tearing their ACL, and having a re-tear or tear of the other side later on. The ACL graft is the type of tissue used to create the new ACL ligament . I felt very informed and well cared for. Although a very small percentage of ACL tears can be repaired, the vast majority need to be reconstructed completely with a new ligament. Female sex and younger age are known risk factors for graft failure. Dr. Burnham is amazing. Does he also have an office in Livingston, as well? Walking is limited to in home walking for the first 2 weeks to minimize swelling and maximize knee range of motion. This autograft has a great fixation and takes best. 88% thicker tendon graft compared to a patellar tendon graft. Compared to male athletes, female athletes are more prone to anterior cruciate ligament (ACL) injuries. The two most common graft options use either two of the hamstring tendons or a part of the patella (a fancy word for knee) tendon. Where to harvest a new graft for ACL reconstruction surgery is the big question? Older female athletes who have sustained an ACL tear can often be treated without surgery. We were screened for an x-ray on site, prior to seeing the doctor.

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