Chapter 35 Anterior Cruciate Ligament Reconstruction
Surgical Overview
• ACL reconstruction using a patellar tendon graft is performed using a combination of open and arthroscopic surgery.
• The central third of the patellar tendon is harvested along with a segment of bone from the patella above and the tibia below.
• The graft is passed through the tibial tunnel, through the central part of the knee joint and into the femoral tunnel.
• The graft is fixated by placing interference screws (one in the femur and one in the tibia) between the bone block and respective walls of the femoral and tibial tunnels.
Rehabilitation Overview
• The clinician must consider ACL biology throughout the progression of the postoperative rehabilitation program.
• Graft strength decreases during the period of necrosis and gradually increases as it revascularizes and remodels.
• Graft fixation techniques are an important consideration, as well as biological fixation, and replace mechanical fixation over a 3- to 6-week time frame.
• The patient is progressed via a criteria-based functional progression. Criteria for discharge are targeted between 4 and 6 months after surgery.
TREATMENT STRATEGIES
• Partial weight bearing (PWB) to weightbearing as tolerated (WBAT) (patella tendon) w/crutches, brace locked at 0 degrees
