An extended interview with Dr. Ian Katz, Orthopedic Surgeon, on Double-Bundle ACL Reconstruction
DR IAN KATZ, Orthopedic Surgeon
Q. Tell me about his procedure (double bundle ACL repair) and how does it differ from what was used in the past to fix the ACL?
A. This is what’s called a double-bundle ACL reconstruction. It is not used for everyone, but the way it differs is that in the past we would reconstruct only one of the two bundles of the ACL which contains the anterior medial and posterior lateral bundles and this procedure tries to restore more normal anatomy and kinematics of the knee by reconstructing both bundles of the ACL.
Q. And you said not used for everyone. What helps you determine who it is used for?
A. I think this, I think a standard ACL reconstruction works well for 85 to 90 percent of the patients and about 10 to 15 percent of the patients, occasionally, residual instability persists and for certain high demand patients and high demand sports it is thought that this might be a better procedure.
Q. So this might be for the younger person, the athletes. Talk about some of the people, when you see them you think this might be.
A. This might be for the younger high school, collegiate or even older athlete involved in high risk pivoting, cutting type sports, basketball, football, soccer, and the patient would have to have allograft reconstruction for a double-bundle which means they would have to accept donor tendons as opposed to using your own tendon because you don’t have enough to sacrifice of your own to have a double-bundle ACL reconstruction.
Q. Okay, how long have you been doing this and is this a fairly new procedure?
A. I’ve been doing this for just under a year and probably been popularized locally in Western Pennsylvania for close to two years or two and a half years.
Q. What kind of reaction are you getting from the patients that have had this done?
A. To date I have been very happy with the results of the patients that have had this. Their knees are extremely stable. I have only been doing it for under a year, but to date have not had any serious complications with this operation.
Q. Does it add to what you have to do in the OR? Does it add to the time in the OR?
A. It does add to the time in the OR. Rather than drill two tunnels, one in the femur and one in the tibia, you have to drill four tunnels, two in the tibia and two in the femur. So it does add time to the procedure in the operating room.
Q. How about postoperatively? Any changes for the patients who have the double versus the single as far as recovery time or what they have to?
A. The rehab is the same.
Q. What is a person looking at recovery wise after a surgery like that?
A. I do these operations as an outpatient so you go home the same day. You are usually on crutches for two to four weeks depending if you have any associated meniscal injury or not, and you start therapy within a day of the surgery. The initial therapy is to regain motion in your knee and then after that is regained then we work on strength, and I don’t let patients generally get back to high risk pivoting type sports for six to eight months after this operation.
Q. I can’t believe its same day surgery. I had no idea. Has it always been like that?
A. Usually, in the past, we’ve kept patients over night one night, but for the last few years I’ve been sending most patients home the same day.
Q. Just maybe get your thoughts, part of the show is the health grades data has shown that Memorial is in the top five percent overall clinically and in surgery is one of the areas that we do very well. Does that surprise you? What would you want the public to know about the caliber of surgery here at Memorial?
A. I think that all the departments of surgery or all the divisions in the Department of Surgery at Memorial perform high quality work, and we offer the latest in terms of technology and in terms of procedures here at Memorial in Johnstown.
Q. What is the difference between a single ACL repair and now this double-bundle procedure?
A. The difference is that we try to restore more normal anatomy with the double-bundle reconstruction. The single-bundle reconstruction which we’ve been doing for many years is an excellent operation. I like to use the analogy of all season radial tires which are compromised but are a good solution for 85 percent of the time for all driving conditions but if you are racing a car or driving in icy or snowy weather you might want to have either racing tires or snow tires, and that would be the difference between the single-bundle reconstruction which is good 85 percent of the time and a double-bundle which you might need 10 to 15 percent of the time.