ACL Reconstruction Techniques and their Implications on Rehabilitation
Professor Margaret Frens
Anterior cruciate ligament (ACL) tears are currently one of the most prevalent lower extremity injuries occurring in competitive athletics. The athlete’s goal is usually the same: to return to play as soon as possible. However, ACL reconstruction surgery is notorious for taking approximately six to nine months to heal in order for the patient to return to functional activity. Depending on the patient, various ACL reconstruction techniques can speed up the rehabilitation process while maintaining the integrity of the new ACL graft. While single bundle grafts are standard, easy to harvest, and time efficient, double bundle grafts are more anatomically fitted and produce better overall functional results. To place the grafts, there are various techniques used. Three techniques are compared based on efficiency and overall outcomes over the course of this research. The anatomic anteromedial technique, a standard procedure, is performed by drilling holes from the outside of the knee into the femur and tibia, threading the new ACL graft through the holes, and securing with screws. Rehabilitation lasts approximately 36 weeks. The All-Inside technique uses a Retro Flip Cutter to drill the femoral and tibial holes from the inside of the knee out, creating sockets. There is less trauma to the bones, therefore, the patient is able to reach functional activity sooner. This technique is especially indicated for skeletally immature patients. Lastly, the Shelbourne technique takes the new ACL graft from the contralateral, healthy patellar tendon. The trauma is then dispersed between both knees, speeding up the rehabilitation process to only nine weeks. Advantages and disadvantages to all of these techniques are compared and analyzed based on current research and local orthopedic opinions.
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