St. Louis surgeon Dr. Rick Lehman pioneers knee procedure

Following the 2013 discovery of a new ligament in the knee, a St. Louis orthopedic surgeon, Dr. Rick Lehman, is pioneering a new procedure that he believes is a medical breakthrough for the most common knee injury.

Late last year, Dr. Lehman began changing the procedure he used to reconstruct a portion of the knee following an injury to the anterior cruciate ligament (ACL). By simultaneously repairing the ACL with the recently-identified anterolateral ligament (ALL), Lehman said the results are proving to be nothing short of ground-breaking.

“You are going to be able to return the athlete to the playing field with less obstructions, less problems and less setbacks,” said Lehman, the founder and medical director of the Lehman Joint and Performance. “Once athletes [return from the ALL/ACL surgery], their mechanics are going to be pretty normal,” he said.

Lehman said there are about 200,000 ACL injuries each year, with almost half of them requiring surgery to repair a ruptured ligament. According to the 2013 study from Belgium’s University Hospitals Leuven, the ALL is present in 97% of all knees. Moreover, researchers believe that when you injure your ACL you also injure the ALL.

Improper stability of the knee and susceptibility to re-injury are the primary pitfalls to the traditional isolated ACL surgery, which is routinely performed in outpatient facilities across the nation.

“It appears that the strength in the leg, the rotational stability in the leg and the other structures that you fix are substantially more supported when you reconstruct the ALL [with the ACL],” said Lehman.

As a former professional team physician, Lehman says the new technique should lessen the impact of arthritis developing later on.

“If you get the mechanics of the knee back to normal, you correct rotation and you correct instability, the joint is going to wear more normally,” said Lehman. “In 15 to 30 years, you will have far less arthritis than you would have had if you had a conventional ACL reconstruction.”

The “double bundle” process is similar to the modern-day ACL surgery, and only adds about 15 to 20 minutes to the normal arthroscopic procedure.

First, Lehman said he secures the proximal part of the ACL, then identifies the femoral tunnel, through which he drills a tunnel. Lehman then drills a tibial tunnel securing the proximal portion of the graft using a 5mm bio screw. Next, he must secure the distal part of the ACL, before the final step—securing the distal ALL using a 7 mm swivel lock anchor.