Anterior cruciate ligament hamstring rehabilitation protocol. Double bundle acl reconstruction begins with identification of the tibial a and femoral b insertion sites of the am and pl bundles. The anteromedial am bundle appears more tensed in flexion, while the posterolateral pl bundle appears more tensed in extension. The graft will be split into 2 strands, 1 to recreate the posterolateral pl bundle, the other to recreate the anteromedial am bundle of the acl. Single bundle or double bundle for acl reconstruction.
You have to go for an acl reconstruction, however, youve read that single bundle or double bundle are options available to you. Ifyouhavesufferedanacute acl injuryandsurgeryisplanned,thetimebetweeninjuryand. Tab blackburn singlebundle versus double bundle anterior cruciate ligament reconstruction. Acl reconstruction should be performed once the knee has recovered from the acute injury, has a full range of motion, and is pain free in order to optimise the.
Anatomic doublebundle acl reconstruction request pdf. Subjects in this arm will undergo anatomic doublebundle acl reconstruction using an autograft quadriceps tendon with a bone block. Overthetop doublebundle revision acl reconstruction. Rehabilitation guidelines for bonetendonbone autograft acl reconstruction. Anterior cruciate ligament reconstruction accelerated rehab this rehabilitation protocol has been designed for patients with acl reconstruction who anticipate returning to a high level of activity as quickly as safely possible after surgery. In order to restore stability to the knee, your doctor may recommend an acl reconstruction to insert a new ligament in the place of the damaged acl. Facts transformation of the graft into a strong and durable ligament requires four months.
Microsoft word gallandacldoublebundleprotocolmay20. In recent times, the anatomic double bundle acl reconstruction is found to be better in restoring the intact knee kinetics compared to the traditional single bundle surgery when done accurately 2. Do you routinely perform a double bundle acl reconstruction. Small, native acl doublebundle and single bundle acl reconstruction after acl rupture did not differ for quality of life at 2 years gobbi, alberto md. It is held together by several important ligaments.
Ok to stretch into flexion per patient comfort 2xday immediately postop. Today, the two mainstay choices are hamstringtendon and bonepatellar tendonbone autografts, with preferences differing around the globe. Singleand doubleincision doublebundle acl reconstruction. Hamstring acl reconstruction rehabilitation protocol muscle strengthening and endurance training muscle contains type 1 endurance and type 2 fasttwitch fibres in varying amounts. A 5 indications and contraindications the medial portal technique is versatile and can be used with any acl graft type and for any primary, revision, single or doublebundle acl. The guide to rehabilitation of anterior cruciate ligament acl reconstruction introduction anterior cruciate ligament surgery and rehabilitation have undergone dramatic changes over the past decade, due to extensive clinical experience, improved surgical. The most common mechanism that tears the acl is the combination of a sudden stopping motion on the leg while quickly twisting on the knee.
Single and doublebundle techniques may provide similar outcomes in patients undergoing acl reconstruction, as noted in new research. Anatomic anterior cruciate ligament reconstruction utilizing the. Joints are named for the two bones that articulate with each other. Doublebundle reconstruction of the acl did not improve function or. Physiotherapy following acl reconstruction protocol rehabilitation following anterior cruciate ligament reconstruction aclr is an essential part of a full recovery. Nonoperative acl injury adopted 398, revised 704, revised 109 1 general principles. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. It should be stressed that this is only a protocol and should not be a substitute for clinical decision making regarding a patients progression. Do you routinely perform a doublebundle acl reconstruction. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving.
Anterior cruciate ligament acl revision rehabilitation protocol the following is a protocol for postoperative patients following acl reconstruction. The purpose of this article is to present a novel technique consisting in a nonanatomic doublebundle acl revision reconstruction, using a freshfrozen achilles. This technique describes an anatomic acl reconstruction that uses two totally independent bundles, through two femoral and two tibial tunnels. Since the first report of surgical repair for a ruptured cruciate ligament in 1895, a great deal of research has attempted to identify the optimal surgical technique. Avoid any extension beyond 30 degrees for 2 weeks postop. Download full article learn how we can help you stay active request a consultation. Revision acl presents many technical issues that are not seen in the primary acl reconstruction. Review article singlebundle versus doublebundle anterior. Single bundle acl reconstruction techniques do not exactly reproduce these two functional units, since their aim is to restore only the am bundle. A newer technique, called a doublebundle acl reconstruction, has been developed to better replicate the function of the normal. Anterior cruciate ligament reconstruction accelerated rehab. In addition, complete acl tears can lead to longterm problems, including instability and an early onset of arthrosis of the knee. Singlebundle and doublebundle reconstructions of the knee were performed sequentially in randomized order on the same side using eight human amputated knees. A graft that stretches or ruptures during this time period is not repairable.
The sequence of reaming and drilling the tibial tunnels for doublebundle acl reconstructions has not been defined. The early effects of isokinetic muscle training on knee joint muscle. Acl technique double bundle attempts to reproduce the normal acl anatomy fu etal superior anterior and rotational stability clinical implications still unknown nih clinical trails in progress not indicated. According to an ongoing study in the united states, an estimated 200,000 acl reconstructions aclr are performed annually, and the incidence of acl injury is roughly one in 3000 per year. Complete acl double bundle graft fixation tension both the am and pl soft tissue grafts in full extension and fixate with the selected tibial fixation device. At about three weeks following injury, the pain is usually subsiding and the swelling is lessened. Rehabilitation guidelines for bonetendonbone autograft. A variety of surgical techniques for revising acl reconstruction have been described in the literature to address these concerns. Acl reconstruction rehabilitation protocol one of the most common complications following acl reconstruction is loss of motion, especially loss of extension. The study shows patients in both groups demonstrate similar. In about two thirds of all complete acl tears there is concomitant damage to the menisci and the cartilage of the knee joint. Acl reconstruction rehabilitation protocol 4 control pain and swelling crushed ice or an aircast knee cryocuff along with nonsteroidal antiinflammatory medications such as advil, nuprin, motrin, ibuprofen, aleve 2 tablets twice a day are used to help control pain and swelling. Rehabilitation guidelines for posterior cruciate ligament. Acl reconstruction rehabilitation program, however there is little consensus regarding the optimal components of a program.
Following acl injury, these fibres show signs of atrophy wasting away and changes in cellular composition. Rehabilitation protocol for anterior cruciate ligament. Noyes knee institute rehabilitation protocol for primary. We obtained subjective international knee documentation committee and. Double bundle acl reconstruction surgery verywell health. Flex the knee to 45 degrees and pull the limbs of the zip strand for the am bundle until the desired tension of the am bundle is met figure 21. Group i received a singlebundle, singleincision transtibial acl reconstruction. When an athlete tears their acl, the knee will tend to buckle when pivoting or suddenly changing direction. Anatomic studies have demonstrated the anterior cruciate ligament.
The purpose of this study was to compare the anterior tibial translation att of the anterior cruciate ligament acl reconstructedknee between singlebundle and doublebundle acl reconstruction under cyclic loading. Acl reconstruction rehab protocol boston sports medicine. You can now try to stretch the knee to regain motion. Anatomy and biomechanics the knee is a hinge joint connecting the femur and tibia bones.
Early return to strenuous activities 12 34 56 78 912 4 5 6 712 brace. Current concepts for anterior cruciate ligament reconstruction. Single bundle acl reconstruction techniques do not exactly reproduce these two functional units, since their aim. Doublebundle and doubletunnel acl reconstruction with.
The guide to rehabilitation of anterior cruciate ligament. One study has shown better clinical results with an arthroscopic doublebundle tibial inlay construct. At 2 weeks postop, come out of the brace twice a day for extension straightening and flexion. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals. The results of single bundle versus double bundle acl.
Once the four tunnels are drilled c, the grafts are passed. The double stranded semitendinosus and the double or. Acl reconstruction single tibial tunnel double bundle. Biomechanical comparison between singlebundle and double. The most important ligament to the knees stability is the a nterior cruciate ligament acl. Acl reconstruction rehabilitation protocol sports medicine north. All patients were followed at 2,6,12, 24 weeks and 1 a 2 years post operatively. Doublebundle grafts have shown some advantage in decreasing anterior and rotational laxity after surgery, 89 but. Single and doublebundle techniques may provide similar outcomes in patients undergoing acl reconstruction, as noted in research presented today at the american orthopaedic society for sports. Allinside posterior cruciate ligament reconstruction with.
Yes, i perform a doublebundle acl reconstruction in 80% of cases. Place a towel or cloth between the skin and the ice to prevent skin injury. The acl attaches from the front part of the tibia to the back part of the femur. Bike 30 minutes with moderate resistance, elliptical with interval training, flutterstyle for swimming no flippers, no breaststroke kick. Anterior cruciate ligament acl injury occurs with a four to six fold greater incidence in female athletes compared to males playing the same landing and cutting sports8. The studies were critically evaluated to determine potential advantages of singlebundle or doublebundle reconstructions in anteroposterior stability, graft tension, rotational stability, and functional outcome. Small, native acl versus doublebundle acl reconstruction. Acl repair rehab protocol articular cartilage paste graft rehab protocol. Rehabilitation of athletic movement and return to sport. A metaanalysis article pdf available in knee surgery sports traumatology arthroscopy 225 december 20 with 448 reads. Groups ii and iii received a doublebundle reconstruction with a singleincision transtibial technique or a doublebundle, twoincision outsidein technique, respectively. Ajsm 2009 doublebundle anterior cruciate ligament acl reconstructions involve drilling 2 tibial tunnels separated by a narrow 2mm bone bridge. Rehabilitation following anterior cruciate ligament acl reconstruction has undergone a relatively rapid and global evolution over the past 25 years. Passive and active range of motion between 30 70 degrees for 4 weeks.
Crushed ice or an aircast knee cryocuff along with nonsteroidal anti inflammatory medications such as advil, nuprin, motrin, ibuprofen, aleve 2 tablets twice a. Able to descend stairs, double leg squat hold for 1 minute. Op rehabilitation protocol the following is a protocol for postoperative patients following acl reconstruction. It is not intended to be a substitute for ones clinical decision making. The resulting anatomic acl reconstruction should provide a repair that more. Noyes knee institute rehabilitation protocol for primary acl reconstruction. Singlebundle acl reconstruction offers positive results.
The anteromedial am bundle appears more tensed in flexion, while the. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Singlebundle versus doublebundle posterior cruciate. This protocol must be followed to prevent injury to the acl graft.
A newer technique, called a doublebundle acl reconstruction, has been developed to better replicate the function of the normal acl. The acl rehabilitation protocol for patellar tendon, quad tendon, and hamstring autografts is similar. However, the results should be interpreted with caution and further largescale, welldesigned rcts on this topic are still needed. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain. The doublestranded semitendinosus and the double or. Yes, i perform a double bundle acl reconstruction in 80% of cases. This can happen in a sport such as basketball, for example, when a player lands on the leg when coming down from a rebound or is running down the court and makes an abrupt stop to pivot. Disruption of the acl is among the most frequent musculoskeletal injuries affecting physically active men and women. Anatomic studies have demonstrated the anterior cruciate ligament consists. If you have suffered an acute acl injury and surgery. Singlebundle, doublebundle, anterior cruciate ligament, reconstruction, metaanalysis introduction the anterior cruciate ligament acl is an. A short video that discusses why you might be better off with an acl surgery double bundle procedure. In this study, all single bundle and double bundle acl reconstruction surgeries that were done in our university hospital from january 2008 to december 2012 were enrolled.