Primary Anterior Cruciate Ligament Reconstruction Using Contralateral Patellar Tendon Autograft

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Primary ACL reconstruction using a contralateral patellar tendon autograft is an effective means of achieving symmetrical range of motion and strength after surgery. When the graft is harvested from the ipsilateral knee, the rehabilitation for the ACL graft and for the graft-donor site are different and have opposing goals. Rehabilitation for the ACL graft involves obtaining full range of motion, reducing swelling, and providing the appropriate stress to achieve graft maturation. Rehabilitation for the graft-donor site involves performing high-repetition strengthening exercises to regain size and strength, best achieved when begun immediately after surgery.

Section snippets

Rationale for Using the Contralateral Patellar Tendon Autograft

The ultimate goal of ACL reconstruction is to restore the injured knee to normal—that is, equal to the contralateral knee. Ideally, the goal is to obtain symmetry between knees in range of motion, strength, stability, and function. Rehabilitation after ACL reconstruction involves two different factors. First, rehabilitation for the ACL graft includes obtaining full knee range of motion to stretch the graft to length and not capture the joint. The other goal is to provide the appropriate amount

Preoperative Rehabilitation

Patients who have an acute ACL injury must undergo rehabilitation before ACL reconstruction. Delaying surgery until preoperative rehabilitation goals are met helps prevent one of the major complications from surgery, loss of knee range of motion [17], [18]. The goals of the preoperative rehabilitation program are to regain full knee range of motion, minimize swelling, and obtain good leg control and normal gait. To attain these goals, a cold/compression device (Cryo/Cuff, DonJoy Orthopaedics,

Operative Technique

There are many techniques for ACL reconstructions that involve using different surgical instruments, graft choice, and fixation devices. The authors perform a two-incision miniarthrotomy technique for ACL reconstruction, which has been described in detail elsewhere [22]. This technique allows easy visualization and access to the both ACL footprints and the landmarks that lead to the appropriate tunnels and graft placement. The evidence has shown that an arthrotomy does not slow the

Postoperative Rehabilitation

The clinical outcomes of ACL reconstruction depend on good surgical technique and on rehabilitation. To prevent the morbidity associated with ACL reconstruction, the appropriate rehabilitation program should be done before the surgery and again immediately after surgery. The authors' present philosophy on the rehabilitation of the ACL reconstruction has evolved significantly during past 20 years as they have observed their patients and their results and then adapted their approach to improve

Results of Using the Contralateral Patellar Tendon Graft

Only a few studies have investigated the use of a patellar tendon graft from the contralateral knee for primary ACL reconstruction [15], [30], [31]. Shelbourne and Urch [15] were the first to describe their experience in patients who underwent surgery between 1994 and 1997. Their study compared the results of 434 patients who underwent surgery with a graft from the contralateral knee with the results of 228 patients who underwent surgery with a graft from the ipsilateral knee. The study showed

Discussion

The specific rehabilitation as described for the graft-donor site and ACL-reconstructed knees needs to be done precisely to realize the advantages of the return of strength and range of motion. If a contralateral graft is used, and rehabilitation is not followed, patients undoubtedly will be unsatisfied with the results.

In certain situations the contralateral graft can be extremely helpful for primary ACL reconstruction: (1) in patients who have poor quadriceps muscle strength in the involved

Summary

The autogenous patellar tendon graft is an excellent graft choice for use in ACL reconstruction, and the reported problems associated with its use are related primarily to rehabilitation issues. With the contralateral patellar tendon graft, the goals of rehabilitation program can be divided between the knees. These principles of the rehabilitation should be taken seriously for the best opportunity to restore symmetrical knees and more predictable results without complications.

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