Jeremy Burnham, MD

04/25/2026

Graft choice in ACL reconstruction has shifted noticeably in the last decade, but there's still no single best graft for every patient. The right choice depends on your age, sport, activity level, and personal priorities, and it's always a decision we make together.

Here's how the main options compare:

Patellar tendon (bone-tendon-bone) has been the gold standard of ACL reconstruction for more than 30 years. It heals bone-to-bone on both ends and has the longest track record in cutting and pivoting athletes. The trade-off is a higher chance of anterior knee pain and kneeling discomfort.

Quad tendon autograft has become an increasingly common choice among ACL surgeons. It provides a thick, high-volume graft (with or without a bone plug, depending on technique), preserves the hamstrings, and tends to have lower rates of anterior knee pain compared to patellar tendon.

Hamstring autograft uses tendons from the inner side of the knee. Smaller incision, less early pain, but the hamstrings contribute to dynamic knee stability, so sacrificing them is a real consideration, especially in young pivoting athletes.

Allograft (donor tissue) eliminates harvest-site pain entirely but carries a higher re-tear rate in young, active patients. It's generally better suited for older patients or those with lower activity demands.

We put together a comprehensive comparison guide covering all four options in detail. If you're facing this decision, this is a good starting point for your conversation with your surgeon.

Quad tendon, patellar tendon, hamstring, or allograft? Dr. Jeremy Burnham (Ochsner-Andrews, Baton Rouge) compares ACL graft options using Panther Global Summit data, PIVOT trial evidence, and patient-specific decision-making.

04/24/2026

If you have ever wondered what a torn ACL actually looks like at each stage of recovery, from the MRI on day one to the hop tests at month 9, I just put the whole timeline on one page.

What the images show. What strength and hop test numbers look like at 3, 6, and 9 months. When most people stop limping, when jogging becomes safe again, and when it is actually reasonable to return to cutting sports.

It is the conversation I have in clinic every week, written down with the data behind it.

https://www.jeremyburnhammd.com/torn-acl-before-and-after-surgery-what-the-data-shows/

04/18/2026

A standard primary ACL reconstruction runs 50 to 120 minutes of actual surgical time, averaging about 90 minutes. The full day at the surgery center, though, is closer to 4 or 5 hours.

Most of that day is not the surgery itself. It is check-in, anesthesia setup and nerve blocks, positioning, recovery, and discharge teaching. The OR portion is the smallest piece of it.

What actually moves the clock during surgery:

Graft choice. A quad tendon harvest adds 10 to 20 minutes versus a pre-prepped allograft.

Meniscus work. If we repair a meniscus tear at the same time (which we try to do whenever possible, because saving meniscus tissue protects the knee long term), that is 20 to 60 extra minutes well spent.

LET or ALL augmentation. About 15 minutes added, and in the right patient it meaningfully lowers re-tear risk.

Revision ACLR. These run 2 to 3 hours because we are often staging bone grafting and managing existing hardware.

Our team's times track closely with the 88.4 minute average reported in the 2022 AANA database for isolated ACLR. Efficient, but never rushed.

Full breakdown, including what happens in pre-op and recovery:
https://www.jeremyburnhammd.com/how-long-does-acl-surgery-take/

04/18/2026

Most ACL recovery guides talk in 6-week chunks. Patients live week by week.

I just published a granular walkthrough of the first 12 weeks after ACL reconstruction: what to expect on day 7, what the brace should (and shouldn't) be doing, when crutches come off for most people, and the one milestone in the first week that matters more than any other.

It also covers the 70/85/95 percent strength thresholds we use at the Ochsner-Andrews ACL Center of Excellence, how a meniscus repair changes the early protocol, and why the "9 months to return to sport" rule isn't actually a date. It's a testing battery.

Worth sending to anyone who is about to have ACL surgery, or anyone who is three weeks in and wondering if they're behind.

https://www.jeremyburnhammd.com/acl-surgery-recovery-week-by-week/

After an ACL reconstruction, most patients want something more practical than a phase chart. They want to know what is happening this week, whether their

04/13/2026

Can you walk on a torn ACL? Most people can, and that's exactly what makes this injury so deceptive.

This guide covers why walking ability doesn't equal knee stability, the research on ACL "copers" vs. "non-copers," how bone anatomy affects instability risk, and data showing that delaying evaluation beyond 6 months significantly increases meniscal damage.

Key finding: even partial ACL tears show measurable rotational instability that patients don't feel during walking, and complete tears are even worse. Early evaluation matters.

Read the full guide: https://www.jeremyburnhammd.com/can-you-walk-on-torn-acl/

04/08/2026

GLP-1 medications like Ozempic (semaglutide) and Mounjaro (tirzepatide) are helping millions of people lose weight. The results are real, and for many patients the metabolic benefits are life-changing. But there's a trade-off with these medications that I think every patient should understand.

Up to 40% of the weight you lose on a GLP-1 may not be fat. It can be muscle and bone.

A 2024 clinical trial (Hansen et al., eClinicalMedicine) studied semaglutide in adults with increased fracture risk over 52 weeks. The findings: hip bone mineral density decreased by 2.6% and lumbar spine density decreased by 2.1% compared to placebo. Bone breakdown increased while bone building did not.

Another study (Look et al., the SURMOUNT-1 DXA substudy) showed that tirzepatide reduced lean body mass by nearly 11% over 72 weeks.

This does not mean GLP-1s are dangerous or that you should avoid them. It means that if you are taking one, you should be proactive about protecting your bones and muscle mass.

Who should be especially aware? Post-menopausal women, adults over 50, anyone losing weight quickly, people who are not exercising regularly, and anyone not eating enough protein.

Four things I consider essential for patients on GLP-1 therapy: resistance training at least three times per week with compound movements like squats and deadlifts, protein intake of 1.2 to 1.6 grams per kilogram of body weight each day, daily calcium (1000-1200mg) and vitamin D3 (1500-2000 IU), and a baseline DXA scan so you know where you're starting.

The medications are a powerful tool. But the best outcomes happen when weight loss is supported by a plan that protects what you don't want to lose. Swipe through for the full evidence breakdown.

04/04/2026

Deonte Campbell, a running back from Baton Rouge, shares his inspiring journey of recovery. With the help of his team and therapy, he's back on the field, stronger than ever. 'Stay positive, stay committed to your recovery,' he urges others. 'You're gonna be better than you were before.'

04/04/2026

Don't let your young athlete specialize too early! Experts recommend 3-4 months off from a sport to prevent injury and burnout. Studies show most top athletes played multiple sports and avoided specializing until mid-teens. Early specialization doubles the risk of quitting sports by age 13.

04/02/2026

You've probably heard that creatine is bad for your kidneys. Or that it's just for bodybuilders. Or that it causes hair loss.

Let me give you the actual evidence.

Creatine monohydrate is the most studied ergogenic supplement in sports science history. 70+ years of research and over 500 published peer-reviewed studies. The ISSN Position Stand concluded it is the most effective nutritional supplement available for high-intensity exercise performance and lean body mass.

The kidney concern stems from a misunderstanding: creatine metabolizes to creatinine in the blood, a standard marker used to assess kidney function. When you supplement, your creatinine rises. That is normal metabolism, not kidney damage. Multiple controlled trials in healthy individuals show no adverse renal effects.

The "just for bodybuilders" assumption? Contradicted by the data. 47,000 people search "is creatine for women?" every month. Women have lower baseline creatine stores than men, and multiple studies show they respond equally well or better. Older adults fighting muscle loss and patients recovering from orthopedic surgery are among the strongest candidates.

For orthopedic recovery specifically: after surgery, disuse atrophy starts quickly. Creatine supplementation alongside physical therapy helps preserve lean muscle mass and support neuromuscular function during rehabilitation.

One angle worth knowing: the brain runs on the same phosphocreatine energy system as muscle. A 2021 review in Nutrients (Roschel et al.) found evidence for creatine's role in brain energy metabolism and cognitive function, including reduced mental fatigue and improved processing speed. This is particularly relevant for athletes managing high training loads, older adults focused on brain health, and anyone dealing with the cognitive demands of competition and recovery.

The dose is straightforward: 3-5 grams of creatine monohydrate per day. No loading phase. No complicated timing. Just consistency.

Swipe through the carousel for the full breakdown, including the myth-busting on the side effect concerns.

03/31/2026

If you've been taking collagen and not seeing results, timing might be the issue.

The beauty industry markets collagen for skin. As an orthopedic surgeon, the evidence I pay attention to is about tendons, ligaments, and joints. It's not settled science, but it's more compelling than most people realize.

Here's what the research shows:

Shaw et al. (Am J Clin Nutr 2017, PMID 27852613) found that taking vitamin C-enriched gelatin 60 minutes before exercise produced a 2-fold increase in serum markers of collagen synthesis. Tendons have poor blood flow at rest, but exercise increases tendon perfusion. That timing window is when supplemental amino acids actually reach the tissue.

Praet et al. (Nutrients 2019) showed specific collagen peptides combined with exercise significantly improved Achilles tendon pain and function scores vs. placebo.

The protocol that matches the evidence: 15g of hydrolyzed collagen with vitamin C (50-200mg), 60 minutes before training or physical therapy, daily for at least 8-12 weeks.

Supporting studies are small and mostly measure biomarkers rather than clinical outcomes. For athletes managing tendinopathy and patients recovering from ACL surgery or other ligament procedures, the mechanism is the most biologically sound in the supplement literature. The protocol is safe and the evidence warrants the conversation.

Swipe through for the full breakdown.

03/30/2026

Proud of the research coming out of our team at Ochsner-Andrews Sports Medicine Institute.

Luke Bunch PT, DPT presented his research poster at the LOA 2026 Annual Meeting in New Orleans: "Patellofemoral Pain and Subsequent ACL Injury: A 10-Year Population-Based Study."

From 1,232 patients followed over 10 years:

Patients with PFP had a 3.6x higher ACL injury rate than the general population. 83% of those injuries were on the same side as the original PFP diagnosis. Most happened within 10 months of diagnosis.

Patellofemoral pain has historically been treated as a nuisance. This data suggests it may be an early warning signal for ACL susceptibility — and that year one is the window to act.

Congratulations to Luke and co-authors Anthony Drazick MD, Ghislain Aminake MD, Chloe Roy, Erin Biggs PhD, Isabella Beltran, and Jeremy Burnham MD.

03/24/2026

Rotatory instability. It's the part of ACL injury that doesn't get enough attention, and it matters more than most people realize.

When the ACL tears, it's easy to focus on the straightforward back-and-forth looseness of the knee. But the rotational component, the feeling that the knee is going to "give way" during cutting or pivoting, is often what limits an athlete's confidence and ability to return to sport.

Our research has shown that rotatory knee laxity exists on a continuum. In a multicenter study of 354 patients published in the Journal of Bone and Joint Surgery, we found progressive increases in lateral knee compartment translation: 1.4 mm with partial ACL tears, 2.5 mm with complete tears, and 3.3 mm in patients who had already undergone a failed ACL reconstruction (Lian, Burnham, PIVOT Study Group et al., JBJS 2020).

The anterolateral complex of the knee, structures on the outside of the joint, plays a critical role in controlling this rotation. Our anatomic work showed that the superficial iliotibial band alone provides over 50 percent of the restraint to internal rotation, and when you add the deeper layers including the Kaplan fibers, those structures together contribute more than 70 percent of rotational restraint at the flexion angles where cutting and pivoting happen, 60 to 90 degrees (Herbst, Burnham et al., OJSM 2017).

Think of it like a steering wheel. The ACL is a hand near the center trying to control the turn. The anterolateral complex is a hand on the outside rim. The hand on the outside has far more leverage to control rotation, and when it's damaged, the hand in the middle can't do it alone.

For select patients with significant rotatory instability, I add a lateral extra-articular tenodesis to the ACL reconstruction. A 2025 survey of 49 international sports surgeons found 91 percent ranked a high-grade pivot shift as a top indication for this combined approach.

Not every patient needs it, but understanding rotatory instability is a fundamental part of comprehensive ACL care.