Surgery and Rehabilitation Issues for ACL Injuries
Rehab Following Contralateral Patellartendon Grafting
1
Introduction
2
Factors that contribute to arthrofibrosis >
3
Grafting techniques >
5
ACL rupture incidence in females >
6
ACL rehabilitation program >
Your stated rehabilitation period following ACL reconstruction using contralateral patellar tendon grafting is three months. What are the limiting factors and, consequently, do you think that three months will be the fastest possible return time to sports without becoming unsafe?
"On average, it takes about 3 months before patients return to competitive sports. They do, however, return to competitive type drills long before that. I do not believe that patients are unsafe with weak legs. In fact, the weakness appears to be protective for reinjury. Because of the initial weakness, most patients will not be able to perform their sport at a level that will cause them to injure their knee. They will not be running and cutting directions hard enough or jumping high enough to cause injury.
"If going back to sports when their leg is weak is unsafe, then I would have been seeing many graft ruptures early in the postoperative period. Instead, the reinjuries have occurred anywhere from 6 months to 10 years after surgery, with the mean time around 3 years. Patients report to us that it takes about 3 to 6 months of actually playing their sport before they feel that they have returned to their previous level of competition.
"Although I do not believe that there is an early time
when it is unsafe to return, I do believe that the limiting factor for returning
to normal is our ability to rehabilitate the donor site. Using the contralateral
patellar tendon graft has allowed us to understand this process better and has
allowed patients to achieve symmetrical strength and range of motion back to
the preoperative level. I have not found a down side for using the contralateral
patellar tendon graft. There are many critics who say, 'How could you think
about taking the graft for a normal knee!' My answer is, 'How could you think
about taking the graft from the same knee given that many patients never regain
symmetrical strength or range of motion between knees?'"
5 ACL rupture incidence in females >
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