Summary
The purpose of this talk will be to present the 6 step ACL paradigm and evidence-based rationale for concepts, techniques and technologies to optimize prevention, performance and care of all athletes in the short, medium and long term.
Abstract
Injuries to the anterior cruciate ligament (ACL) can be a devastating injury to all athletes. Potential and common deleterious consequences include a decrement of performance, re-injuries and post-traumatic osteoarthritis. The objectives in all athletic medicine programs are prevention, optimizing performance and injury care and rehabilitation. As a consequence, we have developed a 6 step ACL Paradigm for now and the future that is based on the sequential program that includes evidence based operative and non-operative concepts techniques and technologies. Successful implementation requires focus, discipline and progression of innovations which include:
1. Prevention of the sentinel Injury rate with an ACL Prevention program such as PEP or FIFA 11+to reduce the burden of ACL injury for all ages and levels especially for the young female athlete. ACL injury rates can be reduced by up to 72-76% in male and female athletes. This requires global implementation with compliance and adhesiveness to programs.
2. Stabilization the knee with reconstruction with an anatomic autograft that may require anterolateral ligament reconstruction and remnant preservation and biological graft augmentation with PRP or BMAC and scaffold bone to achieve efficient graft maturation and ossification of tunnels. The optimal goal is stabilization, while creating a rapid healing of ligament and bone to minimize the rate of re-injury.
3. Preservation of articular cartilage and menisci through resurfacing cartilage defects and repair of and preservation of Menisci with contemporary arthroscopic tools and PRP or biologic augmentation to optimize meniscal repair, survival and function.
4. Optimization of rehabilitation, strength and return to play protocols and progressions for optimal performance by utilization of targeted neuromuscular programs and neuro-cognitive coaching to achieve ideal strength, cortical motor control and biomechanical intactness over time.
5. Utilization of ACL prevention and neurocognitive training programs to impact and minimize the potential of ipsilateral or contralateral reinjury.
6. Prevention of Osteoarthritis and its progression by reversing or modifying the catabolic intraarticular milieu and establishing an anabolic homeostasis while minimizing degeneration over time.
The purpose of this talk will be to present this paradigm as 6 steps with evidence-based rationale for concepts, techniques and technologies to optimize prevention, performance and care of all athletes in the short, medium and long term.