1. Jenny Jefferis Tarryn Hardgrove

2. 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

3. 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

4. Signs and Symptoms  A pop may be felt or heard  Pain  Instability  Swelling  Limited ROM

5. MRI

6. 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

7. Autograft  Bone-patellar tendon-bone  Quadrupled semitendinosus/gracilis tendons  Quadriceps tendon

8. Images

9. Allograft  Achilles tendon with attached calcaneal bone  Bone-patellar tendon-bone  Anterior tibial tendon  Posterior tibial tendon

10. Images

11. 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

12. Considerations for Rehabilitation  Type of graft used  Allograft or Autograft  BPTB, Achilles, Semitendinosus…  Other injuries or repaired structures  Meniscal repairs  MCL injury

13. 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

14. Rehabilitation Plan  Weeks 3 -12: Post-op  Pain  Edema  Muscular Control  Active ROM  Proprioception  Conditioning

15. Rehabilitation Plan  Post-op: Months 4-6  Pain  Edema  Muscular Control  Active ROM  Proprioception  Conditioning  Functional Exercises  Functional Tests

16. Surgical Video  Double Bundle ACL Surgery Double Bundle ACL Surgery