Second ACL injuries, whether it be a tear of the ipsilateral ACL graft or the native contralateral ACL, continue to be of great concern to patients and sports medicine practitioners particularly during the first 1-2 years after surgery. Sending a patient back too early to play is widely considered a major risk factor for this 2nd injury. As health care providers, we take pride in the joy and confidence a patient expresses as he/she advances through a rehab process towards his/her goals. However, when it comes to ACL reconstruction rehab, overconfidence may put the patient at risk, and perhaps slow and steady wins the race. We welcome Dr. Takehiko Matsushita, MD, PhD from Kobe University in Japan to discuss his study investigating the relationship between psychological readiness to return to sport and the risk of a 2nd ACL injury. His findings show that the biggest favor we can do for a patient who accelerates through the ACL recovery period quickly and confidently may be to slow him/her down.

The right surgery for recurrent patellofemoral instability remains a topic of controversy. While medial patellofemoral ligament reconstruction (MPFLr) is the standby surgical procedure for this condition, many adjuncts including tibial tubercle osteotomy (TTO) are performed concurrently with the hope of improving the chances of success. Historically, a tibial tubercle-trochlear groove (TT-TG) distance greater than 20 mm has triggered surgeons to perform TTO, however recent evidence suggests this may be unnecessarily aggressive. We welcome Dr. Mininder Kocher, MD, MPH from Boston Children’s and Harvard Medical School to discuss his study evaluating the outcomes of MPFLr alone versus MPFLr + TTO in patients with recurrent patellofemoral instability with a tibial tubercle-trochlear groove (TT-TG) distance greater than 20 mm.

Despite our technological advances in ACL surgery, the rehabilitation period remains challenging, particularly when it comes to lingering quadriceps weakness. Blood Flow Restriction (BFR) Therapy has been introduced as a potential means to speed up the return of quad function. We welcome Dr. Kelechi Okoroha from the Mayo Clinic to discuss his high-level study, “Effects of Perioperative Blood Flow Restriction Therapy Program on Early Quadriceps Strength and Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction.” By utilizing BFR in both the pre- and post-operative periods following ACL reconstruction, Dr. Okoroha and his team did demonstrate a benefit in strength and patient reported outcomes.