
The Sports Docs Podcast
193: ACL 2.0: Playbook for Reducing Retear Risk with Dr. Pat Smith and Dr. Aaron Krych (REBOOT)
Live from the Arthrex Team Physician Controversies Conference (& Happy Labor Day!) In this episode of The Sports Docs Podcast , Dr. Ashley Bassett and Dr. Catherine Logan sit down LIVE from the Arthrex Team Physician Controversies with two leading ACL experts—Dr. Pat Smith and Dr. Aaron Krych—to discuss strategies to reduce failure after ACL reconstruction . The conversation highlights the evolution of ACL surgery, focusing on graft selection, fixation, biologic augmentation, and mechanical protection , with an emphasis on optimizing outcomes in young, high-risk athletes . Graft: Autograft vs Allograft Strong evidence shows higher failure rates with allograft in young athletes MOON data: ~4–6x increased risk of failure in patients Allograft best for: Older, lower-demand patients Revision or multi-ligament cases Autograft Selection Graft choice depends on: Age, sex, sport, and anatomy BTB: Preferred for high-level pivoting athletes Strong fixation, less graft elongation Quadriceps tendon: Increasingly utilized Larger graft diameter Less donor-site morbidity vs BTB Particularly useful in younger and female athletes Key insight: Grafts Internal Brace (IB) Indications: Young athletes Hyperlax patients Revision ACL Benefits: Decreased graft elongation and cyclic displacement Reduced postoperative laxity Lower rerupture rates (~1% at 5 years in some studies) Faster return to sport and improved rehab confidence Lateral Extra-Articular Tenodesis (LET) Strong evidence supports reduced failure rates: Primary ACLR: ~11% → 4% (high-risk patients) Revision ACLR: ~21% → 5% Benefits: Decreased pivot shift Improved return to pre-injury sport Cost-effective in high-risk populations Indications for LET Age ≤25 years High-grade pivot shift Knee hyperextension Return to cutting/pivoting sports Revision ACL reconstruction LET Surgical Technique Pearls IT band graft (7–8 cm x 1 cm) Passed under or near LCL depending on technique Fixation near lateral epicondyle Pearls: Fix in neutral rotation and ~30–60° flexion Avoid overconstraint Close IT band defect Featured Guests Dr. Pat Smith – Hospital for Special Surgery Naples Dr. Aaron Krych – Mayo Clinic, Team Physician for the Minnesota Timberwolves Stay Connected Apple Podcasts Spotify YouTube Follow us on Instagram for more insights on cutting-edge sports medicine, athlete recovery, and performance https://www.instagram.com/thesportsdocspod/ Our Hosts: Catherine Logan, MD, MBA https://www.cloganmd.com/ Ashley Bassett, MD https://orthopedicnj.com/physicians/ashley-bassett www.thesportsdocspod.com

