EMPOWER
MD Clinical Education Series
Dr. Barrett Little
ACL Reconstruction, LEAP/LET & Shoulder Instability
We sat down with Dr. Barrett Little, an orthopedic sports surgeon with OrthoCarolina practicing in Fort Mill and Indian Land, to discuss modern ACL reconstruction strategies and how surgical decision-making can significantly reduce re-injury risk—especially in young, high-risk athletes. Dr. Little has a strong sports medicine background (Temple University med school, Duke sports fellowship) and practices very much in line with our Athletic Performance Therapy model, emphasizing movement quality, biology, and shared decision-making between surgeon and PT. Much of the discussion focused on lateral extra-articular procedures (LEAP/LET vs ALL) as a “belt-and-suspenders” approach to address rotational instability and reduce ACL failure rates in hyperlax, female, revision, and pivot-sport athletes. He also covered graft choice trends (BTB and quad over hamstring), meniscal preservation, posterior tibial slope considerations, and shoulder instability management, including Bankart repairs, Hill-Sachs lesions, and remplissage in appropriate patients. Ideal referrals include adolescent and young adult athletes with suspected ACL tears, revision ACLs, recurrent instability, complex meniscal injuries, and shoulder instability cases requiring surgical nuance.
Clinic Location: OrthoCarolina – Fort Mill / Indian Land
Contact Information: Dr. Barrett Little
Email: barrett.little@orthocarolina.com
Phone: (804) 873-5448
His biggest pet peeve?
- When extension deficits, stiffness, or slow progress aren’t communicated early—Dr. Little strongly prefers PTs to text him directly if something doesn’t feel right so issues like AMI, stiffness, or meniscal concerns can be addressed before they escalate.
Key takeaways for our team:
- ACL failure risk is multifactorial—hyperlaxity, rotational instability, posterior tibial slope, and meniscal integrity all matter, making early PT input and MD collaboration critical.
- Return-to-sport is earned, not timed—waiting closer to 9–12 months and prioritizing quad strength, movement quality, speed, and confidence aligns perfectly with APT principles and reduces re-tear risk.