01/09/2026
Here we have a ski instructor in their mid 30s, just over three months after an ACL primary repair, feeling great and back on the slopes.
I am skiing this week in Whistler. My happy place. Playing in one to two feet of fresh snow. While riding the lift, I found myself next to another ski instructor in his mid 30s riding up with a friend.
They were talking about peptide injections for stubborn knee pain. That caught my attention. It turns out he had undergone a patellar tendon ACL reconstruction three years earlier and was still struggling with debilitating anterior knee pain.
I repair close to 90 percent of my skiers, with an approximate reinjury rate of one percent per year, or about five percent at five years post op.
Patellar tendon reconstruction typically requires nine to twelve months of recovery and carries a similar five percent reinjury rate at five years.
The difference is the morbidity. Conservative estimates suggest that 20 to 40 percent of these patients develop recalcitrant anterior knee pain, often with permanent difficulty kneeling.
Repair patients do not have anterior knee pain. They recover in a fraction of the time. And their failure rates are comparable to reconstruction.
Reconstruction for all is an antiquated approach. It should be replaced by a thoughtful, Preservation First™ approach.
Just because reconstruction works does not mean it is the best option.
