The portals and skin incision are then stitched together, completing the surgery. Patients usually take part in formal Physical Therapy after ACL reconstruction. The surgeon removes the torn ACL and puts the new graft into the knee, making sure to line it up just like the original ligament. When the surgeon implants the new graft, the bony plugs on each end of the graft fit inside a tunnel of bone. Related Document: Sports Rehabilitation Unlimited's Guide to Anterior Cruciate Ligament Injuries. You shouldn't eat or drink anything after midnight the night before. And problems in this area can keep the quadriceps from regaining normal control and strength. Exercises: Patellar mobilization Be sure to discuss the risks and your concerns with your anesthesiologist. What problems can happen with this surgery? A second surgery may be needed to replace the graft if it is stretched or torn. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Patients who have this operation generally get back to their usual activities and sports. General Guidelines ⢠Brace: Locked in full extension for walking and sleeping for first week May allow 90 degrees flexion after first week given: 1. 0000013650 00000 n ACL reconstruction is the surgical treatment of choice to Many patients go home the same day as the surgery. SLR Brace will be worn for 4 weeks to protect graft, 0 to 90 degrees Most surgeons perform this surgery using an arthroscope, a small fiber-optic TV camera that is used to see and operate inside the joint. They often do so faster than people who have their ACL reconstructed with other types of tissue grafts. Rehabilitation Guidelines for Bone-Tendon-Bone Autograft ACL Reconstruction . The operation doesn't require the surgeon to open the knee joint. If you need to stop suddenly, your muscles must react with just the right amount of speed, control, and direction. %%EOF The tube placed in your knee at the end of the surgery is usually removed after 24 hours. ROM: Extension: Full. The anatomy of the graft helps to speed healing and to create a solid connection. ACL Reconstruction Rehabilitation Protocol 6 3) Heel slides are used to gain final degrees of flexion. This is called a pulmonary embolism. replacing the torn ACL with a graft. <]>> trailer Q` �T� You and your surgeon should make the decision to proceed with surgery together. Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. This continuous motion is thought to reduce stiffness, ease pain, and keep extra scar tissue from forming inside the joint. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. The patellar tendon is a thick and strong band of connective tissue on the front of the knee. Muscle stimulation and biofeedback, which involve placing electrodes over the quadriceps muscle, may be needed at first to get the muscle going again and to help retrain it. Patellar Tendon Autograft. Page 2 ACL Patella tendon allograft protocol Phase I . There are approximately 200,000 anterior cruciate ligament (ACL) injuries per year in the United States and more than half will be treated with ACL reconstruction. The ACL graft is the type of tissue used to create the new ACL ligament . (a) The ACL reconstruction with a bone-patellar-tendon-bone autograft The middle third of the patellar tendon, complete with its bony attachment at either end, is removed from the ACL-deficient knee. Most surgeons take preventing DVT very seriously. 0000013464 00000 n If your surgery and rehabilitation go as planned, you may only need to do a home program and see our Physical Therapist every few weeks over the four to six month period. Cory Edgar, M.D. 12/16 Week Functional Test (Following ACL Reconstruction) Achilles Tendon Repair Protocol; ACL Hamstring Graft Protocol; ACL Patellar Tendon Graft Protocol; Anterior and Posterior Capsular Shift and Superior Labral Repair Protocol; Anterior Capsular Shift/Bankart-Type Repair Protocol; Arthroscopic SLAP Repair Protocol; Basal Joint Arthroplasty Protocol Only small incisions are needed during arthroscopy for this procedure. This strip of patellar tendon is then surgically fitted into the appropriate positions on the femur and tibia to mimic a natural ACL. After surgery, the body attempts to develop a network of blood vessels in the new graft. All rights reserved. It's easy to get to, holds well in its location, and generally heals fast. Flexion: 110 degrees Problems can occur at the donor site (the area below the patella where the graft was taken from the knee). 0000005872 00000 n This new graft includes the strip of tendon, along with attached plugs of ⦠The surgeon takes out the middle section of the patellar tendon below the kneecap (patella). Acl reconstruction is a commonly performed procedure for the orthopaedic surgeon that generally yields good results that allow an athlete to return to activities. Pros: The patellar graft is strong, as the graft from the knee tendon includes bone which âfusesâ into your knee nicely. When revascularization is complete, strength in the graft gradually builds. In rare cases, heavy use of the quadriceps muscle (on the front of the thigh) can cause the patella to fracture. These problems can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. However, remarkable advances in knowledge of this process have been made based primarly on animal models. Agility makes it possible to change directions quickly, go faster or slower, and improve starting and stopping. The plan of care should be based upon the You may use a continuous passive motion (CPM) machine immediately afterward to help the knee begin moving and to alleviate joint stiffness. Copyright (2019) Sports Rehabilitation Unlimited. ACL Patella Tendon Autograft Reconstruction Protocol ACL Patella Tendon Autograft Reconstruction Protocol The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone an ACL patellar tendon autograft reconstruction. A very small number of patients have problems with anesthesia. The anterior cruciate ligament (ACL) is a major stabilizer of the knee joint. 0000002692 00000 n The bone plugs are rounded and smoothed. This key knee ligament is commonly torn during sports activities. Most ACL surgeries are now done on an outpatient basis. This often requires a second surgery to repair the broken patella. On the day of your surgery, you will probably be admitted to the surgery center early in the morning. 457 0 obj<> endobj Figure 4: Heel slide - leg is pulled toward the buttocks COPYRIGHT*2014*CRC*©BRIAN*J. startxref Section of patella and tendon removed x�bb�b`b``Ń3� ���ţ�1�a� ��� 0 to 6 weeks . We are less aggressive initially with hamstring tendon grafts because soft tissue to bone healing takes longer (approx 12 weeks) in comparison to bone to bone (approx 8 weeks). Weeks 0 to 3: Protective Phase. The most common options include patellar tendon, hamstring tendon, and donor tissue (allograft). Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. The standard operation to fix a torn ACL is with a patellar tendon graft. 0000005517 00000 n ACL Bone Patellar Tendon Bone Reconstruction Allograft / Autograft Rehabilitation Protocol Weight Bearing Brace Range of Motion Therapeutic Exercises PHASE I 0-4 weeks As Tolerated with Crutches* Week 1: locked in full extension for ambulation and sleeping Weeks 1-4: unlocked for ambulation, remove for sleeping** 0000005367 00000 n 0000000676 00000 n And you'll begin learning some of the exercises you'll use during your recovery. Weight Bearing: Full, with crutches for safety . Walking with full knee extension 5. The anterior cruciate ligament (ACL) is a major stabilizer of the knee joint. Straight leg raise without a knee extension REHAB PROTOCOL FOR ACL RECONSTRUCTION USING PATELLAR TENDON AUTOGRAFT . The main goal of ACL surgery is to keep the tibia from moving too far forward under the femur bone and to get the knee functioning normally again. What does the surgeon hope to accomplish? Your surgeon may suggest a complete physical examination by your regular doctor. x�b```f``�c`a`��e�c@ >�r`�o�`���p�D��q��������QdU�YFA����@5"~(f`c�e��|��!��.�Cs��� MJ3�4[1C@�fe`�� This new graft includes the strip of tendon, along with attached plugs of bone on ⦠0000001090 00000 n Welcome to Sports Rehabilitation Unlimited's patient resource about Patellar Tendon Graft Reconstruction of the ACL. When using the patellar tendon as an ACL graft, surgeons remove a strip from the middle of it. The anterior cruciate ligament (ACL) is a major stabilizer of the knee joint. It is not intended to be a substitute for oneâs clinical decision making. After ACL surgery, this ability doesn't come back completely without exercise. �jbBc"�ޏO�3���.�����9k���j1����R�k��ٜfDD��^s���"EB4�{��}slXB)]t�����Ն�Ac��_�(dD1c�s�Gpz�n.�~��u�:*���t���>�^|�|zӋ/�x����/Ӯۇ��ؖ�˰A$�4�ao\�7�Yb�a".�֔����6���4��%M��~I��]�ٳ�킳���ƣړjZ����Γ��p��U��E\%��2.��%�Q���p�y�DE�H����?���a2�YmJf��%�5������e�=��}w� =���l) ���?��ޔ*��}iNR��[��.��I�Tq5�A�g�1���|��b������a�П� F50��E�{D�Hx�DF������%�x��.HdN7'�����Xhp����ZX�Iq6����i��v���Ҿ�4�� L�:�o�>�^!�G�,�i���ҕ�}�lV��}ʪ���%~�({jT��t��D There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible after surgery. Walking without crutches 3. These are important skills for walking, running, and jumping, and especially for sports performance. A second purpose of the preoperative visit is to prepare you for surgery. In rare cases, this has been linked to a tear in the patellar tendon. Your therapist will teach you how to walk safely using crutches or a walker. P/;9SZfź�-]RJxH�%f M������N .���1u�d���o]v�1\o1g�99[�V����hWN Solid, isometric quad contraction 3. 0 Although the time required for recovery varies, you will probably be involved in a Sports Rehabilitation Unlimited progressive rehabilitation program for four to six months after surgery to ensure the best result from your ACL reconstruction. The graft is weakest during this time, which means it has a greater chance of stretching or rupturing. 457 19 Next, the surgeon prepares the knee to place the graft. Continue to avoid resisted knee extension. endstream endobj 475 0 obj<>/W[1 1 1]/Type/XRef/Index[20 437]>>stream Many types of tissue grafts have been tried. Most patients are encouraged to modify their activity choices. Portions of this document copyright MMG, LLC. Reciprocal stair climbing 6. This key knee ligament is commonly torn during sports activities. This new graft includes the strip of tendon, along with attached plugs of bone on each end. The CPM is often used with a form of cold treatment that circulates cold water through hoses and pads around your knee. Roy Beebe, M.D. Related Document: Sports Rehabilitation Unlimited's Guide to Knee Anatomy. ACL PATELLAR TENDON AUTOGRAFT RECONSTRUCTION REHABILITATION PROTOCOL ! 0000006160 00000 n Existing clinical trials, registry studies, and meta-analyses offer conflicting opinions regarding the most favorable graft choice. Also, the patellar tendon may become easily inflamed. Following surgery, you may be told by your surgeon to avoid putting weight on the leg and limiting any active quadriceps contractions for up to six weeks. You'll use crutches for two to four weeks in order to keep your knee safe, but you'll probably be allowed to put a comfortable amount of weight down while you're up and walking. Goals Protect graft and fixation Full active extension (compared to uninvolved knee) to 90 degrees flexion Control pain and effusion Tonic, sustained isometric quad contraction with SLR Normal gait pattern . This process, called revascularization, takes about 12 weeks. This may cause the leg to swell and become warm to the touch and painful. For this reason, it is sometimes referred to as a bone-patellar-tendon-bone graft. Brace: Knee immobilizer when walking . Many surgeons prefer to use the patellar tendon when reconstructing the ACL. Some patients stay one to two nights in the hospital if necessary. The patellar tendon is not as strong as it was before surgery. During the procedure a tunnel is drilled through the tibia and the new ACL graft is passed through it and anchored into place. The knee becomes unstable with a ruptured ACL and the joint may become more damaged over time. Our goal is to help you regain full knee extension as soon as possible. This exam helps ensure that you are in the best possible condition to undergo the operation. It starts at the bottom of the patella and fastens just below the knee to a bony bump on the front of the tibia, called the tibial tubercle. This is the âgold-standardâ for ACL reconstruction and has been used for over 40 years as a reliable, safe graft for ACL reconstruction. Of 800 patients who underwent intraarticubr ACl patellar tendon-bone graft reconstruction, performed by 0000003178 00000 n Sports Rehabilitation Unlimited's Guide to Anterior Cruciate Ligament Injuries, Sports Rehabilitation Unlimited's Guide to Knee Anatomy, what parts of the knee are treated during surgery, what to expect before and after the procedure, pressure stockings to keep the blood in the legs moving, medications that thin the blood and prevent blood clots from forming. ACL RECONSTRUCTION WITH PATELLAR TENDON GRAFT I. options as to what tissue is used for the ACL graft (the three most common are patella tendon, hamstring tendon, and cadaver tendon) and each patient should consult with his or her surgeon to determine the best choice. You may also need to spend time with the Physical Therapist who will be managing your rehabilitation after surgery. Our Physical Therapists may recommend a functional brace for athletes who intend to return quickly to their sports. 0000002938 00000 n This allows you to get a head start on your recovery. ACL Hamstring Tendon Autograft Reconstruction Protocol . Each of these choices has advantages and disadvantages. The surgeon begins the operation by making two small openings into the knee, called portals. 0000003255 00000 n The surgeon takes out the middle section of the patellar tendon below the kneecap (patella). This can weaken the patella. Orthopedic Surgeon Dr. Paul Kiritsis takes out the middle section of the patellar tendon below the kneecap (patella). It also resembles the size and length of the ACL (anterior cruciate ligament) that is needed and is technically easier for a surgeon to do this. The patellar tendon graft has proven to be one of the strongest for ACL reconstruction. The anterior cruciate ligament(ACL) is important for maintaining stability of the knee joint, particularly in activities involving weaving, pivoting or kicking. The ACL is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to the front of the tibia (shinbone). This key knee ligament is commonly torn during sports activities. Hold for 5 seconds. This protocol is intended to be a general guideline. These portals are where the arthroscope and surgical tools are placed into the knee. Full extension 2. ACL Hamstring Tendon Autograft Reconstruction Protocol The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone an ACL hamstring tendon autograft reconstruction. 0000001574 00000 n As your Sports Rehabilitation Unlimited rehabilitation program evolves, we will choose more challenging exercises to safely advance your knee's strength and function. Some of the most common complications following patellar tendon graft reconstruction of the ACL are: Most surgical procedures require that some type of anesthesia be done before surgery. 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. Care is taken to protect the nearby nerves and blood vessels. Healing at the bone-to-bone surface fixes the patellar tendon graft in place. Screws are used to hold the bone plugs in the drill holes. The ACL runs through a special notch in the femur called the intercondylar notch and attaches to a special area of the tibia called the tibial spine.
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