The current study indicate that an accelerated postoperative protocol is equivalent in terms of laxity, patient satisfaction, functional performance and activity level and better in terms of clinical outcome to a standard rehabilitation protocol after an isolated ACL-R using STG autografts. Previous article Next article Keywords Rehabilitation
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Is ACL reconstruction right for me?
May 01, 2017 · The current study indicate that an accelerated postoperative protocol is equivalent in terms of laxity, patient satisfaction, functional performance and activity level and better in terms of clinical outcome to a standard rehabilitation protocol after an isolated ACL-R using STG autografts. Previous article Next article Keywords Rehabilitation
Does the biomechanical dose of rehabilitation after ACL reconstruction affect knee healing?
42 patients undergoing ACL reconstruction were randomized to receive either an accelerated or non accelerated rehabilitation program to determine their effects on knee envelop laxity. At 2 year follow-up, there was a significant increase in knee envelope laxity compared to initial post-surgical measures in both groups. There were no differences in terms of laxity, clinical, functional, or ...
Is there an overall protocol for ACL rehabilitation?
Background: The relationship between the biomechanical dose of rehabilitation exercises administered after anterior cruciate ligament (ACL) reconstruction and the healing response of the graft and knee is not well understood. Hypothesis: After ACL reconstruction, rehabilitation administered with either accelerated or nonaccelerated programs produces the same change …
Is the anterior cruciate ligament (ACL) a good target for repair?
Postoperative rehabilitation programs are believed to influence clinical outcome. The purpose of this paper was to outline the evolution of postoperative rehabilitation following anterior cruciate ligament reconstruction. Because of the controversy …
What are 3 types of ACL repair?
In general, there are three main graft options: a patellar tendon autograft, a hamstring autograft, and an allograft. An autograft comes from the patient's own body, whereas an allograft comes from a cadaver donor.
How do you accelerate ACL in rehab?
The accelerated ACL post-op rehab protocol includes:Eliminating swelling by lying down with the knee above the heart for the first seven days.Full extension exercises beginning the day of surgery.Hospital stay for 23 hours.Weight-bearing allowed as tolerated for bathroom privileges.More items...•Jan 9, 2020
What's the fastest ACL recovery?
The mid-1990s case of former Vikings tailback Terry Allen marked the first really effective and immediate return from an ACL injury, but it's worth noting Allen's occurred during a July 1993 practice, giving him a full calendar year to recover before putting together a 1,031-yard season in 1994.Oct 30, 2012
What is the best ACL surgery?
The patellar tendon graft (PTG) has always been the gold standard for anterior cruciate ligament (ACL) reconstruction. Yet, most orthopedic surgeons prefer hamstring grafts for younger athletes and cadaver grafts for older patients.
Why is my knee so stiff after ACL surgery?
Knee postoperative stiffness manifests as an insufficient range of motion, which can be caused by poor graft position, cyclops lesions, and arthrofibrosis [5,6,7]. Previous studies reported that after ACL reconstruction, the incidence of joint stiffness was between 4 and 38% [8].May 14, 2020
When can I bend knee after ACL surgery?
When the patient can control their range of motion progression, their perceived threat is reduced and motion often comes back easier. Knee flexion is restored more gradually, with about 90 degrees achieved at 1 week and full knee flexion gradually advanced and achieved by week 4-6.Jun 3, 2021
How long will I be out of work with an ACL surgery?
If you work in an office, you may be able to return to work after 2 to 3 weeks. If you do any form of manual labour, it could be up to 3 months before you can return to work, depending on your work activities.
Why does ACL rehab take so long?
Like all ligaments, the ACL takes a very long time to heal. The reason is because ligaments are poorly vascularized. In other words, there aren't many blood vessels to provide nutrients for the ligaments, and without nutrients, tissue repair is not possible.Sep 19, 2018
How long does it take to be able to walk after ACL surgery?
Patients walk unassisted within 2-4 weeks, but for short periods. After 10-12 weeks, expect brisk walking, light jogging, and even plyometric exercise. Full recovery on ACL reconstruction is 6-12 months, or more with physical therapy.
Which ACL graft is strongest?
The strongest option is the BTB graft. The graft incorporates more solid into the bone due to the bone plugs on either end of the tendon. However, BTB grafts have been known to have the slowest recovery time when it comes to meeting rehab milestones and returning to sport.Jun 2, 2021
Is a repaired ACL stronger?
Benefits. The bone portion of the graft allows it to incorporate and heal very quickly into the tunnels used for the reconstruction. It is quite strong. Biomechanical studies have shown that it is about 70% stronger than a normal ACL at the time of implantation.Nov 3, 2020
Are screws used in ACL surgery?
Bioabsorbable interference screws are used extensively in orthopaedic procedures, and they are frequently used for graft fixation in ACL (anterior cruciate ligament) reconstruction.Feb 5, 2014
How to Cite
OrthoEvidence. Accelerated vs non-accelerated rehabilitation in ACL reconstruction patients. ACE Report. 2013;2 (7):235. Available from: https://myorthoevidence.com/AceReport/Report/953
Synopsis
42 patients undergoing ACL reconstruction were randomized to receive either an accelerated or non accelerated rehabilitation program to determine their effects on knee envelop laxity. At 2 year follow-up, there was a significant increase in knee envelope laxity compared to initial post-surgical measures in both groups.
Why was this study needed now?
The relationship between duration of rehabilitation exercise program and healing response of the knee is not fully understood. This study examined the effects of an accelerated versusa non- accelerated rehabilitation program on knee envelope laxity in patients who have undergone ACL reconstruction.
What was the principal research question?
Does an accelerated rehabilitation program produce similar joint laxity outcomes compared to a non accelerated program for patients who have undergone ACL reconstruction?
What should I remember most?
There were similar increases in knee envelope laxity during the 2 year follow-up in both groups. Both rehabilitation methods produced similar clinical, functional, and patient satisfaction outcomes.
How will this affect the care of my patients?
Both rehabilitation programs produced similar results. The rehabilitation program should be chosen based on patient and physician preference.
Associated Data
All studies used to formulate this article are freely available online and readily searchable through PubMed (MEDLINE), EMBASE and Cochrane Library databases. A full list of references is included within the manuscript.
Abstract
This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques.
Review
Ligamentous injury in the athlete is a major cause of morbidity and time away from sport (Waldén et al. 2001, 2016; Brophy et al. 2012; Lundblad et al. 2013 ). Ligamentous repair remains an ongoing aspiration in the treatment of athletic patients in order to try and facilitate a rapid and complete return to high level sporting activity.
Anterior cruciate ligament injuries
Anterior cruciate ligament injuries account for anywhere between 25 and 50% of ligamentous knee injuries (Risberg et al. 2004) and pose unique clinic problems because of its poor capacity to undergo biological healing due to the local intra-articular conditions.
Mechanical stability
Animal studies (Fleming et al. 2008) showed that repairing a torn ACL to the tibial stump, does not improve sagittal plane laxity intra-operatively. The likely reasons for this are due to the inherent difficulties in placing a stitch in a short ligament stump composed primarily of longitudinal fibres.
Biologically enhanced repair
Thus far we have talked about techniques such as IBLA and DIS, which aim to aid in improving the mechanical environment. Although, initial results show an improvement from the > 50% failure rates reported by Feagin and Curl 1976, there is clearly still some room for improvement with failure rates of up to 15% seen with these new techniques.
Timing of surgery
If this is the case we need to consider timing of surgery. Animal studies have shown that there is a significant reduction on repair strength with delays of even 2 weeks (Magarian et al. 2010) showing a 40% decrease.
What is the impact of ACL injury?
An ACL injury leads to static and functional instability that causes changes in motion patterns and an increased risk of osteoarthrosis. In many cases, an ACL injury results in a premature end to a career in sports.
Why is CKC important for ACL rehabilitation?
CKC-exercises play an important role in ACL-rehabilitation because they result in a hamstrings-quadriceps co-contraction that reduces tibiofemoral shear forces. Besides, research showed that during CKC-exercises body weight provides tibiofemoral joint compression, that also reduces tibiofemoral shear forces [7].
Why is CKC important for ACL?
CKC exercises play an important role in ACL rehabilitation because they result in a hamstrings-quadriceps co-contraction that reduces tibiofemoral shear forces. Besides, research showed that during CKC exercises body weight provides tibiofemoral joint compression, that also reduces tibiofemoral shear forces .
What is the role of CKC in ACL rehab?
Closed kinetic chain exercises (CKC) and Open kinetic chain exercises (OKC) play an important role in regaining muscle (quadriceps, hamstrings) strength and knee stability. Closed kinetic chain exercises have become more popular than Open kinetic chain exercises in ACL rehabilitation.
How long does it take for a patient to move on to functional exercises?
Forward, backward and lateral dynamic movements can be included as well as isokinetic exercises. Month 3. After 3 months, patient can move on to functional exercises as running and jumping. As proprioceptive and coordination exercises become heavier, quicker changes in direction are possible.
Can you do OKC extension on ACL?
Despite these findings, OKC-extension exercises aren’t excluded in ACL-rehabilitation programs, because the same research has shown that OKC-extension exercises from 90° to 60° of flexion could be done safe, without increasing anterior tibial translation or ACL graft strain.
What is the best treatment for a torn ACL?
ACL Treatment Options: Repair vs. Reconstruction. In the majority of patients who have torn their anterior cruciate ligament (ACL), surgery is recommended. The ACL is within the knee joint and is bathed in synovial fluid (normal joint fluid) which actually works to prevent healing of the ACL tear, and also works against our ability ...
What tendon is used for ACL graft?
The “new kid on the block” graft. The quadriceps tendon as an ACL graft has been used for quite some time, but has gained more popularity over the last 5 years as another excellent option. Newer graft harvest techniques and instrumentation has allowed for easy, safe, and reliable graft size harvesting. The quadriceps tendon is a thick, robust tendon above the patella (kneecap). The main advantage of this graft is all the benefits of size, stiffness, reliability of the patellar tendon graft with less of the anterior knee pain risk.
Why is it important to have a surgeon who is familiar with all of these techniques and adjusts them to your specific
Having a surgeon who is familiar with all of these techniques and adjusts them to your specific needs and preferences is key. The most important part about any graft choice is that it is placed into the correct, anatomic location as improper graft position is the number one cause for failure.
Is it safe to graft an ACL?
This is the “gold-standard” for ACL reconstruction and has been used for over 40 years as a reliable, safe graft for ACL reconstruction. This involves harvesting a piece of bone from the patella (kneecap), the central 1cm of the patellar tendon, and a piece of bone from the tibia to create the new ACL. Tunnels are then drilled into the femur and tibia where the ACL anatomically attaches and the graft is brought into these tunnels to create the knee ligament.
Can a hamstring graft be small?
Unreliability of graft size. Even large, muscular individuals sometimes have small hamstring tendons, and this is especially common in smaller, young females. This leads to a smaller graft diameter which in some studies have shown higher risk of re-tear.
Can a hamstring tendon graft cause laxity?
Graft creep – or stretch over time can sometimes cause increased laxity of the ACL graft over time with hamstring tendon grafts. Some more recent studies have suggested higher re-tear rates than patellar tendon grafts. For these reasons, I use fewer hamstring tendon grafts.