Advances in ACL reconstruction continue to push the field toward stronger fixation, improved graft protection, and more biologically friendly implants. In this special sponsored episode of The Sports Docs Podcast, recorded live at the 2026 AOSSM Annual Meeting in Seattle, Drs. Catherine Logan and Ashley Bassett welcome Dr. Seth Sherman to discuss the latest innovations in graft fixation and how they are changing the way surgeons approach ACL reconstruction.

The conversation begins with one of the most important decisions in ACL surgery—graft selection. Dr. Sherman shares his approach to choosing between bone-patellar tendon-bone (BTB), quadriceps tendon, and hamstring autografts, emphasizing how patient age, sex, sport, anatomy, and activity level influence decision-making. He also discusses the growing body of evidence supporting quadriceps tendon autografts, particularly in young athletes and female patients.

The discussion then shifts to the evolution of graft fixation, from interference screws to adjustable-loop suspensory fixation, and the advantages of modern cortical fixation systems. Dr. Sherman explains how the Arthrex TightRope SB represents an evolution in ACL fixation by combining an all-suture, low-profile design with familiar surgical workflow, radiopaque visualization, and secure adjustable-loop fixation.

The hosts and Dr. Sherman also explore InternalBrace™ augmentation, reviewing the biomechanical rationale, surgical pearls, and emerging clinical evidence supporting graft protection during the vulnerable early phases of ligament healing. Together, they discuss how thoughtful implant design and biologic principles are helping surgeons optimize outcomes while preserving future surgical options.

Whether you're an experienced sports medicine surgeon or a trainee learning modern ACL techniques, this episode provides practical insights into the latest advances in ACL reconstruction.

In This Episode

Factors that influence ACL graft selection, including age, sport, sex, and anatomy
The growing role of quadriceps tendon autografts in primary ACL reconstruction
How suspensory fixation has evolved over the past decade
Advantages of adjustable-loop cortical fixation systems
Features and clinical applications of the Arthrex TightRope SB all-suture fixation device
Benefits of preserving bone stock and eliminating permanent metallic hardware
Radiopaque implant visualization and its role during surgery
Technical considerations and learning curve for adopting all-suture fixation
Biomechanical principles and clinical evidence supporting InternalBrace™ augmentation
Surgical pearls for avoiding over-constraint during InternalBrace fixation
How TightRope SB integrates seamlessly with InternalBrace augmentation
The future of biologically friendly, low-profile implant technology in ACL reconstruction

Key Takeaways

ACL graft selection should be individualized based on patient-specific factors including sport, anatomy, age, and sex.
Quadriceps tendon autografts continue to gain popularity due to predictable graft size, excellent clinical outcomes, and lower donor-site morbidity.
Adjustable-loop suspensory fixation has become a reliable and versatile option for modern ACL reconstruction.
The Arthrex TightRope SB combines familiar surgical technique with an all-suture, low-profile design that preserves bone and eliminates permanent metallic hardware.
Radiopaque implant technology offers additional intraoperative confidence while maintaining the benefits of soft-tissue fixation.
InternalBrace™ augmentation functions as a load-sharing construct that may reduce graft strain during early healing while allowing normal rehabilitation when properly tensioned.
Modern ACL innovation continues to focus on preserving biology, minimizing hardware, and improving long-term patient outcomes without increasing surgical complexity.

About Our Guest

Dr. Seth Sherman is a board-certified orthopaedic sports medicine surgeon specializing in arthroscopic and reconstructive surgery of the knee, shoulder, and elbow. He is widely recognized for his expertise in ACL reconstruction, cartilage restoration, and sports injury management, and is an active educator, researcher, and national lecturer dedicated to advancing evidence-based sports medicine.

This episode is sponsored by Arthrex.

Thank you to Arthrex for supporting continuing education and innovation in sports medicine.

Follow The Sports Docs Podcast for conversations with leading surgeons, researchers, and innovators advancing orthopaedic sports medicine through evidence-based education, surgical innovation, and multidisciplinary collaboration.