MbShea@PWP@English@UMCP

ABSTRACT:
ACL tears occur to about 200,000 people annually and 100,000 of those end up receiving a surgical reconstruction of the ligament annually. Most of those patients have surgery without understanding that they can choose which type of reconstruction they receive. The decision is usually highly recommended by the surgeon and most times no real discussion takes place about the type of graft during the consultation. There are three main types of ACL reconstructions and each uses a graft that is either taken from a cadaver, called an allograft, or two different location of the patient’s own body, called autografts. The real difference in the grafts lays in the outcome of the surgery and the different types of pain or weakness associated with each type of graft used. The downside to an allograft is that the patient receives other peoples tissue in their body, which actually works quite well for ligaments, but requires a longer healing process due to slower regrowth of the blood supply to the ligament. As for the autografts, each requires the removal tissue from an existing tendon and transplant of that tissue as the new ACL. One autograft is taken from the hamstring tendon, which can lead to weakened hamstring strength as well as graft site pain. The other autograft is taken from the patellar tendon, which can lead to knee around under the kneecap and also knee weakness. Patients should have an informed discussion with their surgeon to achieve the best possible outcome of surgery.

WC= 249

READERS PROFILE:
The challenging reader would most likely be Orthopedic Surgeons who wish to continue the practices they are accustomed to rather than allowing the patient to have a significant say in the surgical decisions.

READERS RESPONSE:
I believe that the article’s idea of having patients try and quickly learn the science and outcomes of a complex ACL reconstruction in order to help make surgical decisions is blasphemy. I spent six yeas perfecting my ability to treat disorders of the musculoskeletal system and I would greatly appreciate if my patients respected my expertise enough to make the best decision for them. I believe the article should be very careful in directing patients on how to deal with surgeons and this decision because the decision should be arrived at as a team rather than the patient thinking they know what is best.

D -- is one reason for hiding this decision because of the "creepy" factor of tissue donation from cadavers?

Also, any immunity troubles to be considered? What is the recommendation for patients with a documented or suspected immune disorder? Is inflammation check part of the pre-op procedure, say, measuring antibodies or C-reactive protein?