Improved ACL Reconstruction "imported" from France

Dr. Mark Bowen member of French team teaching innovative technique to U.S. Orthopaedic Surgeons

Injuries to the Anterior Cruciate Ligament (ACL) occur with increasing frequency in our active population. There have been numerous refinements in ACL surgical techniques over the past twenty-five years, notably, using the arthroscope to work inside the knee to secure a replacement graft in the normal anatomic position of the ACL.

A new reconstructive technique, CoLS, developed by French surgeons, implants the strongest ACL graft and the surgery is less traumatic to the patient as it utilizes a hamstring tendon rather than a portion of the patella tendon.

How does CoLS work? During the procedure ONE hamstring tendon from the patient is harvested and quadrupled, producing the strongest graft yet available. The graft is then suspended by tapes that are fixed by screws into the bone on either side of the joint. This has been shown to be the most effective method to secure the hamstring graft.

Previously, the most common location to obtain a ligament "graft" from the patient has been a segment of the patients own (autograft) patella tendon or two of the patients hamstring tendons. By using one hamstring rather than two or the patella tendon, the "harvesting" of donor graft is less painful to the patient postoperatively and less likely to lead to long-term symptoms. In the past, hamstring grafts have been more difficult to secure and fix into bone, and, therefore, not as universally popular among Orthopaedic Surgeons. This new technique is unique and revolutionary as CoLS solves the difficult problem of how to effectively attach a hamstring graft to the bone.

Dr. Bowen traveled to visit the innovative French surgical team on several occasions in early 2009, worked on refinements to CoLS and now teaches American surgeons the reconstructive technique. To date, he has performed over 100 CoLS procedures. Dr. Bowen is a member of the French study and advisory group providing worldwide leadership on CoLS. To date, over 10,000 CoLS procedures have been performed in France.

This procedure has an additional and critically important benefit for children and adolescents in need of ACL reconstruction. With the CoLS technique, the growth plates in the knee are less likely to be impacted during surgery as they are avoided completely or atraumatically crossed to minimize any potential injury and growth disturbance. Dr. Bowen believes that CoLS will have a dramatic impact on the choice of reconstructive ACL technique in growing children.