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ACL Rehabilitation: A Review of Current Treatment Approaches: Summary
2. Allografts : For young, competitive athletes, autografts are strongly preferred over allografts: ○ Autografts had a 6% failure rate ○ Non-irradiated allografts had a 9% failure rate ○ Irradiated allografts had a 34% failure rate (statistically significant) While there is some debate between patellar tendon and hamstring autografts, recent literature suggests a slight preference for patellar tendon grafts in terms of long-term outcomes and reduced failure rates. Revascularization/Remodeling Timeline • Weeks 0-2: Avascular necrosis ○ Significant reduction in graft strength • Weeks 3-20: Revascularization • Weeks 6-12: Disorganization of collagen ○ Careful with exercises
INTRODUCTION
INTRODUCTION AND IMPORTANCE OF EVIDENCE-BASED PRACTICE
There is a big emphasis on the importance of staying current with the evolving literature in ACL rehabilitation. Learners are challenged to evaluate their current practices critically and be open to new evidence-based approaches. ACL rehabilitation practices have changed significantly over the years, including surgical techniques/technology, graft choices, rehab- ilitation protocols, and return-to-play criteria . Clinicians need to update their knowledge and practices continually to provide the best care for their patients. Key statistics to underscore the importance of optimizing ACL rehabilitation: • Only about 55% of athletes return to competitive sport at their pre-injury level following ACL reconstruction • Up to 30% of young, active individuals who return to high-risk sports experience a second ACL injury within the first two years after returning to sport These sobering statistics highlight the need for improved rehabilitation strategies and return-to-play decision-making processes. Surgical Considerations and Graft Choices The literature supports ACL reconstruction in young, active adults due to the risk of: • Episodes of instability • Potential for pathological laxity • Injuries to other structures of the knee (i.e., meniscus) The various graft options available for ACL reconstruction include: 1. Autografts : ○ Patellar tendon
• Weeks 12-24: Remodeling and proliferation (collagen maturing) • Week 12-20: Exercise progressions • Week 24: Sport specific drills Early Rehabilitation Phase
The evolution of ACL rehabilitation protocols has shifted towards more accelerated programs. Accelerated Programs: 1. Range of Motion : Aim to achieve unrestricted range of motion by week 4 post-surgery 2. Brace Weaning : Typically wean from the post-operative brace between 2 and 6 weeks 3. Open Chain Exercises : Introduce open chain full extension exercises as early as week 6 or even earlier 4. Closed Chain and Functional Tasks : Begin full range squatting and some functional sports-specific drills around 5-6 weeks.
○ Hamstring tendon ○ Quadriceps tendon
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