Dr. Marx’s new book highlights an evidence-based medicine approach to controversies in ACL reconstruction

Dr. Marx’s new book edited with Dr. Nakamura, Dr. Zaffagnini, and Dr. Musahl, Controversies in the Technical Aspects of ACL Reconstruction, takes an evidence-based medicine approach to discuss the existing controversies in ACL reconstructive surgery techniques. Evidence-based medicine, or when a physician uses the best available literature to assist in decision-making for a patient, aims to optimize a treatment plan for a given patient. Though there is not always an ideal answer for a specific clinical scenario, this book illustrates both sides of the dilemma in as unbiased manner as possible.

In particular, chapters written by Dr. Marx in the book discuss a variety of topics. The book begins by highlighting the importance of ACL injury prevention programs, which incorporate components of proprioception training, plyometric training, neuromuscular training and strengthening into an athlete’s warm-up regimen. In the chapter, Dr. Marx mentions that ideally, these exercises should be performed year-round for maintenance, and prioritized by coaches, parents, trainers and physical therapists.

In addition, one of the book’s more technical chapters discusses the controversies surrounding early vs. delayed ACL reconstruction, and why delayed surgery is often his and his collaborators’ preferred choice. The chapter notes how several risks factors (e.g., arthrofibrosis) of early surgery must be balanced with the risk of further meniscus or cartilage injuries associated with delayed surgery. After detailing the pros and cons, the authors conclude that most recent evidence suggests that, in a small subset of cases with an isolated ACL tear and minimal swelling, good quadriceps control, and range of motion, early ACL reconstruction can be done safely. However, ultimately, excluding these semi-urgent cases, immediately performing an elective ACL reconstruction can place the patient at a higher risk for significant complications with little additional benefit.

As well, additional chapters describe the technicalities of allograft use in ACL reconstruction and ACL reconstruction in the multi-ligament knee. These chapters provide insight into the indications for surgery and post-operative rehabilitation protocols. Overall, from ACL injury prevention to clinical decision-making to surgical technique, this book gives the reader a detailed view of how to best personalize patient care.

View it on Amazon here .

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