Author Credentials

Chad Lavender MD Shane Taylor MD John Johnson ATC Richard Peluso MD Tyag Patel MD Timothy E Hewett PhD

Author ORCID Identifier



ACL, Reconstruction, Biologics, Suture Augment


Medicine and Health Sciences | Sports Sciences



The objective of this retrospective study is to evaluate outcomes in patients who underwent the fertilized anterior cruciate ligament (ACL) reconstruction procedure. We aim to investigate the return to previous level of activity, safety, and re-rupture rates of the ACL reconstruction augmented with bone marrow concentrate, demineralized bone matrix, autograft bone, and a suture tape (the fertilized ACL).


A comprehensive review of medical records was conducted for patients treated with the fertilized ACL (FACL). Medical records of all the patients who underwent reconstruction surgery between July 2018 and January 2021 were evaluated. The inclusion criteria for the study were patients with a defined ACL tear based on clinical examination and magnetic resonance imaging testing who received FACL reconstruction between July 2018 and January 2021. Exclusion criteria included revision ACL reconstruction, non FACL reconstruction, and patients that underwent the FACL reconstruction outside of the defined time period. Thirteen patients underwent reconstruction using a Graftlink allograft (Lifenet Virginia Beach, Va) and 38 using quadriceps autografts. All patients received the FACL reconstruction using bone marrow concentrate, demineralized bone matrix, autograft bone, and suture tape. A phone survey was conducted to obtain patient-reported outcome measures including return to previous level of activity, International Knee Documentation Committee (IKDC), ACL Return to Sport After Injury (ACL RSI), and Visual Analogue Scale (VAS) values. A chart review was conducted for complications and questions were asked during the phone survey regarding return to operating room, infections, and re-ruptures.


Data analysis revealed 94% of the patients returned to their previous level of activity. The average IKDC and ACL RSI scores were 94% (SD, 9.0) and 92% (SD,15.3), respectively. The average VAS score was .9/10 (SD, 1.2). One patient required reoperation for pain at 1 year. No re-ruptures were observed.


This retrospective study sheds light on the FACL, which adds biology and an internal brace to an ACL reconstruction, as a reliable and safe option when performing an ACL reconstruction. Very low complication rates were seen in this consecutive series followed for a mean of 2 years. Patients had an extremely high level of return to previous level of sport/activity.