ACL Part 2

A stiff PTFJ (decreased fibular rise + rotation) means decreased - and -

DF and pronation (ankle)

Indications for surgery

Instability, activity level goals, other intra-articular pathology (associated), poor results from conservative management (3-6m), patient factors

Auto vs allograft

Auto is from yourself, allo from cadaver

BPTB autograft

• Harvest central 1/3 of patellar tendon w bone plugs

• Pro: High RTS, strong, faster healing

• Con: anterior knee/kneeling pain

Hamstring Tendon autograft

• Take Semitendinosus (with gracilis) and fold on itself

• Pros: lower pain, preserves extensor mechanism

• Cons: slower healing, higher failure risk, hamstring weakness

Newer one?

QT autograft, often less painful for kneeling + thicker band + still disrupts extensors

Allografts best for which age group?

Older, less active

Explain graft ligamentization

Process by which a tendon becomes a ligament

• Tensile strength highest immediately after post-op, drops significantly at 3 months, becomes about equal to native ACL at 6-9 months

When doing surgery on kids, there is often - - approach to not disrupt epiphyses (as opposed to - in adults)

Physeal sparing, (transphyseal)

Main problem with RTS?

FEAR

Re-tear rate highest in - - (but less than allograft)

Hamstring autograft

We want >90% - and hopefully a -:1 ratio of lift to BW

LSI, 1

What is the BEAR procedure?

Collagen matrix soaked in your own blood goes into sewed up ACL to heal it by yourself

Meniscectomy/Meniscus repair along with ACL makes things tougher how?

Initial knee flexion limitations/surgical directions

Rehab goals

• 1+2: 0-8 weeks

• Other (KF, gait

• Graft protection, NMES + BFR, ice/compression/elevation, RESTORE FULL KNEE EXT (4-6)

• Get knee flexion back (ex: bike), normalize gait by 4-6 weeks (no AD)

NMES parameters

Frequency: 50-75hz

Pulse Width: 200-400 microseconds

On/Off cycle: 10-15 on, 50 off

Arthrofibrosis development post-ACLR is due to scar tissue in - - (- lesion)

Intracondylar notch (cyclops)

When is the “feeling good” phase going on? Why is this a problem?

8-16 weeks, new ligament is at its weakness

OKC exercises put less stress on the ACL than -

Walking

Readiness to run?

• Typical time to clear

• What you must do

• 12+ weeks

• Full pain-free ROM, minimal to no effusion, quad strength >70%, Torque/BW is 65%

Types of plyos and their requirements

External- foundational, early to mid stages, full ROM/minimal swelling/65-80% LSI

Internal- more specific, full ROM/minimal swelling/80-100% LSI

RTS Battery important elements

1. No pain/effusion

2. Psychological Readiness (ACL-RSI)

3. Strength (T/BW= 1:1)

4. Hop Test (LSI > 90%)

Vertical hopping offers a more - distribution of forces on the LE joints than a horizontal hop

Balanced

Core exercise components for ACLR?

Strength, Plyo, Balance + Proprioception

We want ACL-RSI above -

65