Jenny Jefferis Tarryn Hardgrove
Background 18 Yr. Old Female Basketball Player Guard Division 1 College Injury happened at practice Went up for a rebound, landed on R leg and knee buckled inward Positive Tests Anterior drawer Lachman’s
ACL Sprains Most commonly injured knee ligament Max stress positions Full extension 90 ◦ flexion Common MOI Valgus stress with lateral rotation when foot is planted Sudden knee hyperextension with rotation
Signs and Symptoms A pop may be felt or heard Pain Instability Swelling Limited ROM
MRI
Portals Arthroscopy begins ACL surgery 3 incisions used to create portals Camera feeds image to a monitor Cannula is used for pumping sterile saline solution into the joint
Autograft Bone-patellar tendon-bone Quadrupled semitendinosus/gracilis tendons Quadriceps tendon
Images
Allograft Achilles tendon with attached calcaneal bone Bone-patellar tendon-bone Anterior tibial tendon Posterior tibial tendon
Images
Pros and Cons AllograftAutograft + No donor site + Smaller incisions + Reduced surgery time - Possible rejection - Disease transmission HIV Hepatitis - Cost and availability + Your own tissue No risk of disease No risk of rejection - Patella tendonitis - Patella fracture - Donor site morbidity
Considerations for Rehabilitation Type of graft used Allograft or Autograft BPTB, Achilles, Semitendinosus… Other injuries or repaired structures Meniscal repairs MCL injury
Rehabilitation Plan Week 1: Post-op Pain Edema Passive ROM Muscular Control Week 2: Post-op Pain Edema Passive ROM Muscular Control Normalize Gait Strengthening
Rehabilitation Plan Weeks 3 -12: Post-op Pain Edema Muscular Control Active ROM Proprioception Conditioning
Rehabilitation Plan Post-op: Months 4-6 Pain Edema Muscular Control Active ROM Proprioception Conditioning Functional Exercises Functional Tests
Surgical Video Double Bundle ACL Surgery Double Bundle ACL Surgery