Bridge Enhanced ACL Restoration

[Laramie Hartmann]

Mark,

I've unfortunately found myself with a full thickness tear of the ACL. I was planning on a patellar tendon graft repair, but a buddy mentioned a new Bridge Enhanced ACL Restoration technique now available. Do you have any familiarity with this new surgical procedure and it's effectiveness vs. traditional options?

Thanks.

[Mark Rippetoe]

Age/Height/Weight/Training status/athletic activities.

[Laramie Hartmann]

Age: 42
Height: 5' 9"
Weight: 189
Training Status: Prior to the injury my 5 rep numbers were around

Squat: 305
Deadlift: 375
Bench: 265
Press: 175

After the initial injury, I de-loaded the lower body lifts a few weeks later and worked my way back up. Knee was feeling much better after about two months and I re-injured it pushing off it while stepping into a U-Haul carrying a couch. At this point, I figured something was structurally wrong. MRI concurred. De-loaded again. Squatted 245 for 3x5 yesterday.

I'm fairly active with rock climbing and skiing at a relatively high level.

[Mark Rippetoe]

I had mine repaired when I was about your age, and the graft ruptured about 4 years later. I haven't had any issues with it since then, because I have modified my behavior, as you can learn to do. I have had lots of surgery, and what you learn is that a repaired joint is never original equipment, and thinking that it is will get you hurt. A rather high percentage of the NFL has a ruptured ACL. Strong hamstrings make it almost unnecessary. If you want to have it fixed, I would use an allograft procedure. Do not let them harvest the graft from your hamstring.

[Browndog]

...If you want to have it fixed, I would use an allograft procedure. Do not let them harvest the graft from your hamstring.

Too true, too true...

Where's my time machine!?!?

[Laramie Hartmann]

I've read through previous threads on this topic, and a hamstring or quad graft is out of the picture, but I understood that the patellar graft was/is the gold standard. A cadaver graft runs about $4k extra, and I'll grudgingly pay the additional cost if the outcome is better, but it nearly doubles the cost of the procedure and has a higher rupture rate. I understand that the original equipment ain't coming back, but I want to get as close to that state as possible. Thoughts?

[Mark Rippetoe]

What is the difference in the rupture rate?

[Kazzin]

I have spent the last 27 years of my life with an unrepaired ruptured ACL. Because I don’t play contact sports I haven’t felt limited by my missing ACL in any way whatsoever. Probably not a big deal for most people, especially if you squat correctly.

[Laramie Hartmann]

What is the difference in the rupture rate?

Possibly negligible, depending on age(>40) and allograft type(nonirradiated). The age cutoff seems to be ~40. I suppose I'm old now.

"The QTA group had the lowest mean yearly graft failure rate (0.72%), followed by the BPTBA group (1.16%), the HTA group (1.70%) and the allograft group (1.76%)."

Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade | SpringerLink
Autograft versus allograft in anterior cruciate ligament rec... : Medicine

[Buffaloguy]

I had mine repaired when I was about your age, and the graft ruptured about 4 years later. I haven't had any issues with it since then, because I have modified my behavior, as you can learn to do. I have had lots of surgery, and what you learn is that a repaired joint is never original equipment, and thinking that it is will get you hurt. A rather high percentage of the NFL has a ruptured ACL. Strong hamstrings make it almost unnecessary. If you want to have it fixed, I would use an allograft procedure. Do not let them harvest the graft from your hamstring.

Agree regarding hamstring grafts. I had a hamstring graft for ACL repair in 2014, that hamstring has never been right, is weak, and cramps when I kneel. There are possible issues with patellar grafts as well but I wish I had gone that route.