ACL Revision - Autograft Repair:  Kathryn Brenner

Kathryn BrennerKathryn Brenner was a high achieving athlete during her high school years at Visitation Academy in St. Louis. A soccer player since the age of 4 and on the varsity squads for soccer, basketball and softball, Brenner’s childhood and teen years were filled with high impact sports.

While playing basketball in her sophomore year, she and her team were in a mad dash to the end of the court. “Someone passed me the ball and I went to turn, but another player was standing on my right foot,” Brenner recalls. “I heard a loud pop and fell to the ground.”

Initially Brenner thought she had dislocated her knee, but MRI scans showed a torn anterior cruciate ligament (ACL), one of four ligaments critical for stabilizing the knee. While some individuals can function with a torn ACL and recover with physical therapy, ACL reconstruction often is recommended, especially for highly active people or competitive athletes. Brenner underwent surgery in February 2009.

Six months later, she tore her ACL a second time while sliding into home plate during a varsity softball game. After her parents sought opinions from other physicians, they came to Washington University School of Medicine. Brenner was treated by sports medicine specialist Rick Wright, MD, the Dr. Asa C. and Mrs. Dorothy Jones Professor of Orthopaedic Surgery, a nationally recognized specialist in both primary and revision ACL reconstruction.

Wright leads the largest long-term NIH study evaluating the factors that could cause poor outcomes in revision ACL surgery. Called the Multicenter ACL Revision (MARS) Study, the research project so far has reviewed the cases of more than 1,000 patients at 53 medical centers.

Among the first findings was that repeat trauma and technical problems, such as the angle of repair, definitively affected the chance for a successful outcome in revision surgery. “Our latest findings show that revision outcomes are impacted by the choice of graft we use in the repair,” says Dr. Wright. “We have found statistically significant and better outcomes when we use autografts (a patient’s own tissue) rather than allografts (donated tissue). Autografts improve both return to sports and patient reported outcomes.”

During ACL reconstruction, surgeons use a tendon graft to replace the torn ligament. Typical grafts are the patient’s own hamstring or patellar tendons, or donated tissue. In Brenner’s first surgery, her previous doctor used one of her hamstring tendons. “I didn’t recover from that,” Brenner says. “I couldn’t put pressure on my leg, had to be on crutches longer than I thought, and just had a lot of trouble.”

After Dr. Wright evaluated her new injury and initial repair, he opted for revision reconstruction using part of Brenner’s own patellar tendon.  “It made a huge difference,” Brenner says with relief. “I walked out of the hospital the next day. That was the thing that made me realize I could go back to sports.”

Aggressive rehabilitation through fall and winter enabled Brenner to go back to basketball tryouts the following spring. “She sat in the car for 20 minutes because she was worried about a re-injury,” says Brenner’s mother, Vicki. “But she was back to her competitive self.”

When soccer season rolled around that summer, Brenner recalls a telling moment that eased her fears of re-injury. “There was one game where I slide-tackled a girl and popped right back up,” she says. “That was my tell tale sign I was back.”

In her final two years of high school, Brenner’s soccer team won back-to-back state championships in 2010 and 2011. She was recruited to play soccer at Saint Louis University and is now pursuing a degree in nursing.

“Kathryn was able to have her ACL repaired and came back to an elite level in all of her sports,” says Vicki Brenner. “Dr. Wright gave her the two best years of her soccer career.”

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