ACL Reconstruction Rehabilitation Protocol One of the most common complications following ACL reconstruction is loss of motion, especially loss of extension. Educate re: the importance of icing. Approximately 9-12 months sport/6-12 months work. Elevate leg. Material is obtained from a donor who is a living person, or a deceased person's body receiving mechanical support or ventilation, or a deceased person's body whose heart stopped beating. This protocol is a guideline for post-operative rehabilitation of patients who underwent ACL reconstruction using auto/allograft patella tendon. • Allograft tissue is typically recommended in patient 30-35 years and older. Allografts can be referred to as "homostatic" if they are biologically inert when transplanted, such as bone and cartilage.[2]. A limiting factor in tissue allotransplantation for reconstructive surgery deals with the side effects of immunosuppression (metabolic disorders, malignancies, opportunistic infections) which is a predominant issue. If you have had other major operative procedures, in addition to your ACL repair or if arthritis was discovered during the initial diagnostic arthroscopy. Synthetic and metal implants. 3. This is different from an ‘autograft’ reconstruction, in which the patient’s own tissue is used. ACL graft ganglia are thought to be multifactorial in etiology, with potential causes including mucinous degeneration, partial tearing, incomplete incorporation of allograft tissue, pressure necrosis, and a reaction to bioabsorbable screws. She is an Associate Attending Orthopedic Surgeon at Hospital for Special Surgery and a member of the Sports Medicine Institute and Women’s Sports Medicine Center at HSS. Allotransplant (allo-meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species. 8 Graft ganglia rarely lead to graft disruption, but operative resection of these ganglia may be necessary for relief of pain and/or mechanical symptoms. All Rights Reserved. Main cause of graft failure is the presence of unrecognized, and therefore untreated, PLRI. If you develop acute pain in the back of your calf, tell your doctor. Diet as tolerated B. Allograft revascularization is slower than for autografts. HAMSTRING ALLOGRAFT ACL RECONSTRUCTION REHABILITATION PROTOCOL BENEDICT FIGUERRES, MD WEIGHTBEARING BRACE ROM EXERCISES PHASE I 0-4 weeks Touch-down weightbearing with crutches with strong emphasis on foot flat and full knee extension during stance phase Locked in full extension for ambulation and sleeping* As tolerated Heel slides, quad/hamstring sets, patellar mobs, … An immune response against an allograft or xenograft is termed rejection. Download PDF. The protocol may be adjusted according to patient progress. Also, it can not be forgotten that the risk of transmitting infection is very high. Most surgeons performing ACL reconstruction recommend that high-level athletes (such as collegiate or professional athletes) avoid donor tissue because of higher rates of reinjury to the graft. pros & cons useful in revisions; no harvest site morbidity; longer incorporation time; more expensive than autograft ; risk of disease transmission (HIV is < 1:1.6 million, hepatitis is even greater) increased risk of re-rupture in young athletes . Given the severity of the endophthalmitis, though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. General considerations . * Post Op exercise instruction. It is contrasted with autotransplantation (from one part of the body to another in the same person), syngeneic transplantation of isografts (grafts transplanted between two genetically identical individuals of the same species) and xenotransplantation (from other species). ACL revision procedure have been described, including allograft chips, struts, and autografts from the iliac crest.11,13-15 Bone dowels are structural allografts commercially available in different lengths and diameters to fill the bone defect with varying sizes. While the post-op dressing is in place, icing should be done continuously. Phase 1 – 0-6 Weeks Post-op. And ALLOGRAFT PROTOCOL PHASE I-EARLY FUNCTIONAL (WEEKS 1-2 ) Goals: 1. * Cryo/Cuff instruction * Crutch ambulation training. Of the roughly 720,000 knee replacements performed every year […] Name: _____ Date: _____ 4. [1] The transplant is called an allograft, allogeneic transplant, or homograft. No range of motion until 2 weeks, at 2 to 4 weeks 0 to 20 degrees. Most human tissue and organ transplants are allografts. Knee Arthroscopy, ACL Reconstruction with Allograft Day of surgery A. • Quad sets • Leg lifts • Active flexion/passive extension • Patella mobilization • Quadriceps/Hamstrings isometrics at 90° * Quadriceps re-education. Protocol for Revision, Allografts, Complex Knees This rehabilitation program is for everyone else. • MADISON, WI 53718 PHASE I (Surgery to 4 weeks after surgery) Appointments • © 2021 OrthoVirginia It is more common when allograft tissue from a donor is used rather than autograft tissue (from yourself). Rehabilitation Protocol - ACL Reconstruction Using Allograft; Repair Protocol - Arthroscopic SLAP Lesion; Repair Protocol - Rotator Cuff; Reverse Total Shoulder Protocol; Stress Fracture Treatment; Total Shoulder Arthroplasty Protocol; Hospital & Team Affiliations Hospital & Team Affiliations. * Brace fitting. Appointments: Rehabilitation appointments begin within 3-5 days after surgery and meet about once per week Rehabilitation Goals: 1. 5. Diagnosing PLRI is difficult because it occurs rarely and is slow to develop. Dr. ACL Reconstruction Guideline This rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. Studies have demonstrated that the It is reported to be as high as 15-30% in these younger individuals. Range of motion will be blocked at 0 degrees in a brace for 4 weeks. As with many operations, allotransplantation also has some side effects. ACL reconstructions performed with meniscal repair or transplant follow the ACL protocol with avoidance of open kinetic chain hamstring work for 6 weeks. In the US, donor tissue must be recovered and processed adhering to the Current Good Tissue Practices rule. The second, called the “Donor Eligibility” rule, proscribes criteria for donor eligibility. Therefore, crutches and brace are continued for 6 weeks. Sports Medicine. Even the best studies published so far include a vast array of donor (allograft) tissues: from young and old patients, from hamstrings, Achilles tendons and patella tendons, and from un-registered banks with variable exposure to radiation. The risk of this happening in young athletes/ individuals (< 18 years old) is at least twice as high as it is in older adults. Icing is important for the first 5-7 days post-op. for Individuals with an allograft were 5 times more likely to have an ACL graft failure than those with an autograft. Dr. Marion Herring specializes in sports medicine and the treatment of knee, shoulder and elbow injuries. Figure 5:Photos show the ACL graft, with the first photo shot with the knee in flexion and the second photo shot with the knee in full extension. • ACL reconstruction with allograft is a procedure which involves taking tissue from a cadaver (deceased person who has chosen to donate their tissues) and using that tissue to creat a ‘new’ ACL. or A variety of organs and tissues can be used for allografts, including: In the US, the Federal government Food and Drug Administration (FDA) has regulated human tissue intended for transplants since 1993. Allograft types commonly used in ACL reconstruction include Achilles tendon (A), hamstring tendon (B) and patellar tendon (C). OrthoVirginia is requiring ALL patients & visitors to wear a MASK at ALL times. This protocol is intended to be a general outline only. Purpose: To evaluate the long-term results of primary ACL reconstruction using either an allograft or autograft. Recently, we posted a blog titled “Everyday People Rehabbing Major Knee Injuries with AZOPT.” In this two part series, we focused on the rehab following a major tear in the ligaments of the knee. ACL RECONSTRUCTION – HAMSTRING AUTO / ALLOGRAFT OR POSTERIOR TIBIALIS ALLOGRAFT Post-op Days 1 – 14 Dressing – POD 1: Debulk dressing, TED Hose in place – POD 2: Change dressing, keep wound covered, continue TED Hose – POD 10-14: Sutures/Staples out, D/C TED Hose when effusion resolved – Brace x 6 weeks – Locked in extension for ambulation – Open to available range when pt … He works as the team physician for a local triathlon and endurance racing organization. Eliminate effusion 4. The downside of allograft tissue is that there are numerous studies that have demonstrated that this tissue is not quite as strong as tissue that has not been sterilized and processed. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain. the new ACL graft tearing if there is a new injury to the knee. This page was last edited on 14 January 2021, at 21:35. Noyes Knee Institute Rehabilitation Protocol for ACL Reconstruction: Revision, Allografts, Complex Knees 1-2 3-4 5-6 7-8 9-12 4 5 6 7-12 Brace: postoperative & functional X X X X (X) X X Range of motion minimum goals: 10-80° 0-90° 0-125° 0-135° X X X X Weight bearing: Toe touch – 25% body weight 50% body weight Full X X X The new ligament is most vulnerable 6-12 weeks after surgery. Read our COVID-19 policies. If so, this should be … The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone. After anterior cruciate ligament (ACL) surgery, move your ankles up and down an average of 10 times every 10 minutes. POST-OPERATIVE PROTOCOL Osteochondral Allograft or Autograft Transplantation . Follow ACL Rehab protocol with the following restrictions (if applicable): SURGEON: Dr. Nick Mohtadi Dr. Alex Rezansoff Other DATE OF SURGERY: SURGERY DETAILS: ACL RECONSTRUCTION: Hamstring Tendon Patellar Tendon Quadricep Tendon Allograft LATERAL EXTRA-ARTICULAR TENODESIS: Yes No OTHER LIGAMENT RECONSTRUCTIONS/REPAIR: Yes No Details: MEDIAL MENISCUS: Debridement … The third, the “Current Good Tissue Practices” rule, oversees overall processing and distribution practices of each company. The following are the MAJOR OBJECTIVES of the rehab program: 1. The surgical leg will be weight bearing as tolerated using crutches post-operatively. Restore normal knee range of motion and patellar mobility 3. Conclusion: The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. It can be a complication of knee replacement or anterior cruciate ligament surgery, with infections and bleeding as known contributing factors. ACLR Protocol with Quadriceps Tendon Autograft AND Meniscal Repair ... Start ACL protocol combining Phase 1 and 2. Decrease pain and effusion. Herring continues to train and compete in running and triathlon events, including racing in The Ironman World Championships twice and the Boston Marathon once. Each year, Food and Drug Administration regulated and American Association of Tissue Banks-accredited tissue banks distribute 1.5 million bone and tissue allografts. The physician reserves the right to either advance or delay this protocol as deemed necessary. Please notify me with any questions or deviations from the schedule. 2. Time frames for use of brace and crutches may be extended by the physician. Rehabilitation uidelines for C Reconstruction in the dult thlete (Skeletally Mature) 4 UWSPORTSMEDICINE.ORG 621 SCIENCE DRIVE • MADISON, WI 53711 4602 EASTPARK BLVD.

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