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Lecturer discusses how far ACL research has come, how much is unknown

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BARCELONA — More knowledge of the ACL is needed to fully understand the factors related to nonoperative healing of the ligament, the role of timing of the reconstruction in clinical outcomes and why ACL reconstruction reduces pivot shift in the knee, according to a presenter, here.

In his highlight lecture at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress, here, Jon Karlsson, MD, PhD, said sports injury prevention, particularly injuries to the ACL, should be the focus of more investigations in musculoskeletal medicine. He also called for sport-specific rehabilitation, which is an up-and-coming area, to be more criteria-based and said the result of a shorter and safer return to sport may come from minimally invasive surgery.

Jon Karlsson

“I would like to underline what I call individualized thinking in surgery. There are three things that are important: prevention of ACL injury can be done; timing of ACL reconstruction — we need to do more research; and surgical technique. Improvements are needed. We need to individualize. We need to understand the whole patient, the whole knee, the requirements, the demand,” Karlsson said. 

Karlsson discussed some outcomes of renewed interest in the anatomy of the ACL, including findings from Robert Smigielski, MD, of Warsaw, Poland, that showed the ACL has a flat mid-substance with fibers that seem to form a ribbon. This has also revealed the ACL has more of a C-shaped insertion, Karlsson said.

As for the debate about single-bundle vs. double-bundle ACL reconstruction, “I think the debate is good,” Karlsson said. “The debate will create something. The debate will move us forward.” – by Susan M. Rapp

Reference:

Karlsson J. Highlight lecture: Controversies in ACL surgery — What we know and where do we need to improve. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona, Spain.

Disclosure: Karlsson reports no relevant financial disclosures.