There are two main options for ACL graft selection, allograft and autograft. Autografts are the patients' own tissues, and options include the hamstring tendons or middle third of the patella tendon. Allograft is cadaveric tissue sourced from a tissue bank. Each method has its own advantages and disadvantages; hamstring and middle third of patella tendon having similar outcomes. Patellar grafts are often incorrectly cited as being stronger, but the site of the harvest is often extremely painful for weeks after surgery and some patients develop chronic patellar tendinitis. Replacement via a posthumous donor involves a slightly higher risk of infection. Additionally, donor grafts eliminate tendon harvesting which, due to improved arthroscopic methods, is responsible for most post-operative pain.
The surgery is typically undertaken arthroscopically, with tunnels drilled into the femur and tibia at approximately the original ACL attachments. The graft is then placed into position and held in place. There are a variety of fixation devices available, particularly for hamstring tendon fixation. These include screws, buttons and post fixation devices. The graft typically attaches to the bone within six to eight weeks[citation needed]. The original collagen tissue in the graft acts as a scaffold and new collagen tissue is laid down in the graft with time. Hence the graft takes over six months to reach maximal strength.[citation needed]
After surgery, the knee joint loses flexibility, and the muscles around the knee and in the thigh tend to atrophy. All treatment options require extensive physical therapy to regain muscle strength around the knee and restore range of motion (ROM). For some patients, the lengthy rehabilitation period may be more difficult to deal with than the actual surgery. In general, a rehabilitation period of six months to a year is required to regain pre-surgery strength and use.[citation needed] This is very dependent on the rehabilitation assignment provided by the surgeon as well as the person who is receiving the surgery. External bracing is recommended for athletes in contact and collision sports for a period of time after reconstruction. It is important however to realize that this type of prevention is given by a 'surgeon to surgeon' basis; all surgeons will prescribe a brace and crutches for post surgery recovery total usage time is one month. After surgery no sports for 6 to 7 months. Whether the ACL deficient knee is reconstructed or not, the patient is susceptible to early onset of chronic degenerative joint disease.
Prevention
Research has shown that the incidence of non-contact ACL injury can be reduced anywhere from 20% to 80% by engaging in regular neuromuscular training that is designed to enhance proprioception, balance, proper movement patterns and muscle strength.[3]
A National Institute of Health funded study is underway with the objective of identifying unique movement patterns that predispose female athletes to ACL injuries and evaluate and improve injury prevention programs. The study is overseen by Dr. Christopher Powers at the University of Southern California's Division of Biokinesiology. An initial phase of the project evaluated the Prevent Injury and Enhance Performance (PEP) program developed by the Santa Monica Orthopaedic and Sport Medicine Research Foundation. During the final stage of the study, the Competitive Athlete Training Zone ("CATZ") in Pasadena, CA the ACL injury prevention training program is being enhanced and continually improved by CATZ founders Jim Liston and Kevin Wentz. Information on the PEP program, and the latest developments at CATZ can be monitored at the project website.[4][5]
See also
- Anterior cruciate ligament
- Skiing and skiing topics
- ACL reconstruction
- Sports injuries
- Lachman test
- Unhappy triad
Additional images
 Right knee-joint, from the front, showing interior ligaments. |
 Left knee-joint from behind, showing interior ligaments. |
References
- ^ Catalyst: Weak at the Knees - ABC TV Science
- ^ McLean SG, Huang X, van den Bogert AJ (2005). "Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: implications for ACL injury". Clin Biomech (Bristol, Avon) 20 (8): 863–70. doi:. PMID 16005555, http://linkinghub.elsevier.com/retrieve/pii/S0268-0033(05)00111-7.
- ^ Patrick, Dick (2003-06-24). "Specific exercises may be key to preventing ACL injuries", USA Today.
- ^ http://pt.usc.edu/ACLprojectprevent/pep_tr.htm
- ^ http://www.catzsports.com/
External links
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Knee Pain Questions Answered - Week #2
http://freekneepainreport.com/ - This is part of an ongoing series of weekly segments answering your questions about knee pain. You can send questions to: Bill@TheKneePainGuru.com
Author: TheKneePainGuru
Keywords: Knee Pain The Guru Health Alternative Therapy Bill Parravano Exercises knee pain injury acl pcl meniscus tiger woods ligament bursitis basketball tear torn IR DL football sports health medicine mcl fitness workout help osteoarthritis OPC-3 joints injuries relief interferential treatment electrode placement for drug free therapy popliteal space painful area electronic advice patellar pull rehab strain tendonitis plantar fascitis foot
Added: November 19, 2008
"Happy Prospector" dance/ACL Tear (Remix)
"Happy Prospector" dance + alcohol = Torn ACL
Author: mab0714
Keywords: drunk alcohol dancing injury
Added: November 18, 2008
Knee Pain Relief : ACL Tear Information & Knee Brace Support
If you have torn your ACL you are probably looking for answers to help stabalize your knee and to reduce pain. Watch this video to learn more
Author: drbraceco1
Keywords: acl basketball brace braces don donjoy football joy knee mcl meniscus pain relief running soccer sports www.drbraceco.com
Added: November 17, 2008
"Happy Prospector" dance/ACL Tear
"Happy Prospector" dance + alcohol = Torn ACL
Author: mab0714
Keywords: dancing alcohol injury
Added: November 17, 2008
Knee Pain Relief : MCL Tear Information & Knee Braces For Support
If you have torn your MCL you are probably looking for answers to help stabalize your knee and to reduce pain. Watch this video to learn more
Author: drbraceco1
Keywords: acl basketball brace braces don donjoy football joy knee mcl meniscus pain relief running soccer sports support
Added: November 16, 2008