Biologically Optimized ACL Technique (BOAT Protocol): A Modern Approach to Reconstruction and Recovery

Author: Dr. Reza Jazayeri

When it comes to ACL injuries, particularly in athletes or active individuals, the quality of reconstruction can define not only the timeline of recovery but also the long-term health and performance of the knee. For patients navigating the sea of surgical options in a highly competitive orthopedic landscape, it’s essential to understand not just what is being done, but how and why it’s done.

Dr. Reza Jazayeri’s BOAT Protocol—Biologically Optimized ACL Technique—is the result of over 15 years of high-volume surgical experience, academic teaching, and dedication to advancing orthopedic standards. Every step of this comprehensive protocol is meticulously refined to enhance healing, reduce downtime, and help patients return safely to the activities they love.

What Sets BOAT Apart?

Most ACL procedures focus solely on the ligament reconstruction. BOAT takes it further. From the moment you walk into the clinic to the final phase of rehabilitation, every phase of your care is biologically, mechanically, and metabolically optimized to promote faster, stronger recovery.

Phase 1: Preoperative Optimization

A successful ACL surgery begins before the day of surgery.

Comprehensive Evaluation

• Advanced Imaging: MRI and X-rays are routinely reviewed; CT scans may be used in revision cases for surgical planning.
• Sport-Specific Assessment: A physical examination tailored to your sport, position, and functional goals.
• Metabolic & Nutritional Screening: Bloodwork is performed to assess key markers of hormonal, nutritional, and inflammatory status.
• Body Composition Analysis: Bioelectrical impedance (BIA) is used to measure lean mass and guide nutrition and rehab planning.

Prehabilitation & Nutritional Preparation

• Targeted Exercise Program: Patients undergo a structured prehabilitation protocol combining in-person physical therapy with a digital platform to enhance joint mobility, neuromuscular control, and muscle strength before surgery.
• Amino Acid Supplementation: Focused nutritional support is initiated in the perioperative period to blunt catabolism, preserve lean muscle mass, and prime the tissue environment for accelerated healing.
• Personalized Dietary Program: Each patient receives an individualized nutritional plan designed to maintain peak muscle mass and metabolic readiness, guided by the Muscle-Centric Calculator—a tool used to determine optimal protein intake based on lean body mass and activity level.

Phase 2: Surgical Precision & Biologic Augmentation

The procedure itself is performed using state-of-the-art techniques that emphasize minimal invasiveness and maximum biological support.

Minimally Invasive Graft Harvest

• Quadriceps Tendon Autograft: Harvested arthroscopically with special instrumentation to reduce tissue trauma.
• Closure Augmented with PPP (Platelet-Poor Plasma): Promotes wound healing at the harvest and portal sites—commonly used in plastic and reconstructive surgery.

All-Inside Reconstruction

• FlipCutter™ Socket Creation: Allows precise tunnel placement with less bone removal, reduced postoperative pain, and shorter operative time.
• Internal Brace: A high-strength tape that acts like a “seatbelt,” protecting the graft during early healing and high-risk movements.

Biologic Augmentation

• BioACL Technique with BMAC: Bone marrow aspirate concentrate (BMAC) is harvested from the iliac crest and delivered into the femoral and tibial sockets, enhancing graft incorporation and vascularity through autologous mesenchymal stem cells.
• BioBrace (in select high-risk patients): A bioinductive scaffold that adds structural reinforcement and biological stimulation at the healing interface.
• Lateral Extra-Articular Tenodesis (LET): Used in patients with high risk of retear (e.g., young athletes, hyperlaxity, revisions) to improve rotational stability using the iliotibial band.

Phase 3: Postoperative Recovery & Functional Return

BOAT doesn’t stop in the OR—it continues through every phase of rehabilitation.

Immediate Recovery

• Targeted Amino Acid Supplementation: Administered postoperatively to stimulate muscle protein synthesis and initiate repair.
• Pain Management: Multimodal strategies focused on minimizing narcotic use while maximizing comfort and function.

Rehabilitation

• MyHealthTrack Digital Rehab: Patients engage in tailored rehab protocols aligned with their surgery, graft type, and biological healing timelines.
• In-Person Physical Therapy: Supervised sessions to support proprioception, strength, and return-to-play milestones.

Who Is This For?

The BOAT Protocol is ideal for:

• Athletes seeking a faster, safer return to play
• Patients undergoing revision ACL reconstruction
• Individuals at high risk for graft failure (young, hypermobile, or multi-ligament injured patients)
• Patients who value a modern, science-backed approach to orthopedic care

The Takeaway

ACL surgery is more than just a ligament replacement. It’s a biologically active process involving muscle, tendon, bone, and systemic recovery. Dr. Jazayeri’s BOAT Protocol is designed to optimize every aspect of this process—ensuring the highest chance of success and durability.

For patients who want a comprehensive, elite-level approach backed by surgical expertise and modern science, the BOAT Protocol offers a new standard in ACL care.

Why Patients Trust Dr. Jazayeri for ACL Surgery:

• Faster Recovery: Minimally invasive techniques mean less pain, quicker rehab, and smaller incisions
• Fewer Reinjuries: Advanced graft choices and added stability reduce the risk of future tears
• Preserve Your Own Tissue: When possible, native ligament repair avoids graft harvest and speeds healing
• Enhanced Healing: Biologics like BEAR®, BMAC, and BioBrace™ boost recovery at the cellular level
• Custom-Tailored Care: Your sport, goals, and anatomy guide every decision
• Total Support: Get personalized guidance before and after surgery with expert rehab and digital coaching
• Trusted Expertise: Double board-certified, fellowship-trained surgeon for complex cases and athletes