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Surgical Repair of the ACL/PCL

What type of grafts are there? Autograft, Allograft and Artifical ligaments
What is the difference between an Auto and Allograft? Autograft uses tissue from the body of the pt and the Allograft uses biologic tissue taken from another human body or cadaver
In an Autograft what are the common sites used for grafts? Gracilis tendon, TFL, semitendinosus tendon, and central 1/3 of patellar tendon
Of the sites used for the Autograft what site is the best to use? Patellar tendon because it is the strongest, bone tendon-bone graft(does have longer rehab)
When Allograft is done what site is most commonly used? Gracilis tendon, TFL, semitendinosus tendon, and central 1/3 of patellar tendon and ALSO GASTROC (achilles) tendon
When doing a patella tendon autograft where is the tendons attach to? It is harvested from the involved knee and is surgically routed through tunnels placed in the femur and tibia, then securing the graft to the bone to allow for stable healing
What helps with bleeding after an autograft? A drainage tube is inserted to help evacuate the joint of resdual bleeding. Leg is put in a brace or immobilizer
What is the process of healing following a graft? It begins radual process of Avascular necrosis over the first 6-8 wks.
What happens to the graft after it is put in? Graft loses strength and is fragile during 2 months so avoid excessive forces?
How long does it take a graft to revascularize? 3 months strength is less than 50%, may take as long as a year to mature but may never reach pre-op strength
What are the rehab goals after a ACL/PCL repair? 1.Protect graft 2.>pain and swelling 3.
What are the phases of rehab? Max, post-op to 6 wk, Mod 7-12 post-op, Min,13 week to prior level of activity
Max phase of ACL what do you want to avoid? Hyperextension and rotary motions.
What is the WB status in Max phase of ACL repair? Ambulation WBAT with brace and crutches
What therapy is done in Max phase? PROM, AROM and isometrics at various joint angles.
What are the 6 things done in the max phase of ACL repair? 1.Protect joint with hinge brace to avoid hyperextension and rotary motions 2.Control swelling w/modalities and rest 3.Patellar mobs 4.WBAT 5.PROM,AROM 6.Isometrics at variors joint angles 4.WBAT
When a pt is is the mod phase of ACL repair they should be? FWB/with no brace
During mod phase what is to be avoided in strengthening ex? Any position to avoid hyperextension
What retraining is done in the mod phase? Proprioceptive and CKC ex, start w/brace for CKC & progress to ex without
What are the 5 things done in MOD Phase? 1.FWB no longer needs brace 2.CKC ex and Proprioceptive retraining 3.Stationary bike or elliptical 4.Cont. AROM and stretching 5.Progressive resistance w/strengthening ex
MIN phase of ACL protocal? 1.13 wk have pt return to prior level of activity 2.Progressive propriception ex using dynamic surfaces 3.Progressive strengthening-OKC & CKC using < resistance, weight machines 4.Jogging, running, simulate sport or work activities
Non-op PCL rehab is controversal why? How to best manage a PCL injury either surgery or non but both groups have a high incidence of articular cartilage degeneration as resuld of instability
What is the most important goal in NON-op PCL repair? Strengthening the quad/quad strength exceed that of the unaffected leg
NON-op acute phase what is the first thing to do? A knee immobilizer or hinged brace is used for pt comfort. Rice & NASAIDS are used to min swell & > pain
What are other things done in the acute stage of NON-op rebab PCL? 1.Immobilizer is removed for PROM/AROM 2.FWB is allowed Pt doed quad sets and SLR ASAP
SUB-acute NON-op what are the 3 parts of rebab? 1.Starts when pain,swelling, & quad control impove. Brace removed for ex 2.CKC quad ex are done. Leg press, step ups, wall squats, reverse stair stepper SAQ 3.AVOID open chain resistive hamstring curls
How long to return after PCL NON-op recovery? Return to full activity after 8 weeks
What happens in Post-op surgical PCL ? Same grafts choices as ACL and is either arthroscopic or open tech
PCL max protection Phase are? 1.Hinge brace until FWB & full quad control 2.Limit FWB for 4-6wks 3.AROM limited 50-60 degrees of knee flexion 4.Full ROM 2 months post-op 1-13 wk 5.Protect healing of graft
What rebab is done in MAX phase-PCL surgical repair? -Isometrics and PRE strengthening of quads -Patellar Mods -CKC when FWB and quad control
Why is the mod phase of PCL surgical repair diffenent than ACL? CLC ex emphasize strengthening of quads -partial quats -stairstepper -step ups -lunges -elliptical -bike set set higher
During the mod phase of PCL sur. what is done with proprioceptive and balance retraining? Progress to dynamic surfaces -double leg stance -SL stance -EO OR EC 13-24wk
What is the Min protection phase of PCL post-op phase? 24 wk return to prior functional activities with running jumping and cutting etc
Where is the graft recontructed at? ACL the petalla tendon,along with pedicles of bone from the patella and tibial tubercle is harvested and then surgicaly routed through tunnels drilled through the femur and tibia
Created by: demiller243



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