Topics
Timing
When surgery is the treatment option selected after injury, the procedure should be delayed until the actue inflammatopry process has run its course. Research has shown that early surgical intervention on acutely inflamed knees results in increased post-operative complications, including loss of ROM and functional deficits (Fowler PJ et al, The ACL injury. In: 1994 Advances on the Knee and shoulder 1994; Millett et al AJSM 29:664 2001). Undergoing pre-operative rehabilitation may improve post-operative outcomes and reduce complications.
Graft considerations
Type of Graft
Bone-Patellar Tendon-Bone Autograft: advantages include high graft strength, good fixation due to bone-to-bone healing, ease of obtaining graft material. Disadvantages include complications with extensor mechanism such as patellar fractures, patellar tendonitis, patellar tendon rupture, and anterior knee pain
Hamstring tendon allograft: advantages include fewer extensor mechanism complications and comparable resuls to B-PT-B. Disadvantages include complications with fixation, possible hamstring weakness, technically it is a more complicated procedure
Allograft: advantages include nor complications with donor sites and increased availability of material. Disadvantages include possible disease transmission or recipient rejection (Weber MD in Physical Rehabilitation of the Injured Athlete, 3rd Ed. Andrews, Harrelson, Wilk, 2004)
