EMPOWER
MD Clinical Education Series
Dr. Dana Piasecki
ACL Reconstruction, LET/ALL Nuance & Graft Decision-Making
We sat down with Dr. Dana Piasecki, an orthopedic sports medicine surgeon with OrthoCarolina and nearly 20 years of experience treating complex knee injuries in the Charlotte area. Dr. Piasecki is widely respected for his thoughtful, data-driven approach to ACL reconstruction and his willingness to challenge trends that may be more “standard of care” than evidence-based. Much of the discussion focused on the nuanced role of LET/ALL procedures, emphasizing that while they may be reasonable in very high-risk patients (hyperlaxity, high tibial slope, revision cases, skeletally immature female pivoting athletes), they are often unnecessary for primary ACLs and can add meaningful risk for stiffness, quad inhibition, and prolonged rehab. Ideal patients to send his way include athletes with ACL tears (primary or revision), complex or “high-risk” knee anatomy, and patients seeking second opinions on graft choice, LET/ALL recommendations, or return-to-sport decision-making.
Clinic Location: OrthoCarolina – Randolph Road
Contact Information: Dr. Dana Piasecki
His biggest pet peeve?
Blindly following protocols or going off-script without communication. Dr. Piasecki strongly values PT autonomy and clinical reasoning—but wants early, direct communication when something isn’t working or doesn’t make sense so the plan can be adjusted collaboratively.
Key takeaways for our team:
- Rehab and neuromuscular training may be more protective than extra surgery—year-round neuromuscular training has a stronger failure-prevention signal than LET/ALL in many patients, aligning perfectly with our Athletic Performance Therapy model.
- Meticulous surgery + thoughtful rehab beats “more surgery”—graft placement, quad control, swelling management, and individualized return-to-performance criteria matter far more than adding procedures for most athletes.