Primary Anterior Cruciate Ligament Reconstruction Using Contralateral Patellar Tendon Autograft
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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Cited by (23)
Is contralateral autogenous patellar tendon graft a better choice than ipsilateral for anterior cruciate ligament reconstruction in young sportsmen? A randomized controlled trial
2022, KneeCitation Excerpt :In this way, the contralateral technique seems to be a safe method for patients who need a quick and uncomplicated recovery [14]. The ultimate goal of ACLR is to restore the physical capacity of the injured knee back to normal, i.e. equal to the contralateral knee [12]. The greatest symmetry of muscle strength in the contralateral group, observed in the present study, can be attributed to the possibility of starting rehabilitation simultaneously, however, with different therapeutic objectives for both knees, allowing faster functional gains, without edema and impaired stability.
Patellofemoral disorders and quality of life after primary anterior cruciate ligament reconstruction – comparison between ipsilateral and contralateral techniques using bone-patellar tendon-bone graft after 10 years
2020, Sports Orthopaedics and TraumatologyCitation Excerpt :The possible explanation for these better results is the ability to recover quadriceps strength more quickly during the rehabilitation process with the use of the contralateral BPTB graft[11]. The possibility of division surgical trauma between the two knees seems to provide greater symmetry between the limbs in an easier way, thus decreasing the likelihood of symptom development, since the decrease in function and anterior knee pain are scientifically correlated variables with weakness knee extensor mechanism[23]. Besides that, among the existing studies, it was evidenced that improvements in the symptomatology and function of the knee are directly correlated with higher scores in the SF-36 questionnaire[6,24].
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