Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair

2021 ◽  
pp. 194173812110329
Author(s):  
Jocelyn Wu ◽  
Jamie L. Kator ◽  
Michael Zarro ◽  
Natalie L. Leong
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Ligament Repair ◽  
Acl Repair ◽  
Pubmed Database ◽  
Anterior Cruciate Ligament Repair ◽  
Ligament Augmentation ◽  
Internal Bracing ◽  
Anterior Cruciate ◽  
Repair Techniques

Context: Injury to the anterior cruciate ligament (ACL) is among the most common orthopaedic injuries, and reconstruction of a ruptured ACL is a common orthopaedic procedure. In general, surgical intervention is necessary to restore stability to the injured knee, and to prevent meniscal damage. Along with surgery, intense postoperative physical therapy is needed to restore function to the injured extremity. ACL reconstruction (ACLR) has been the standard of care in recent decades, and advances in surgical technology have reintroduced the prospect of augmented primary repair of the native ACL via a variety of methods. Evidence Acquisition: A search of PubMed database of articles and reviews available in English was performed through 2020. The search terms ACLR, anterior cruciate ligament repair, bridge enhanced acl repair, suture anchor repair, dynamic intraligamentary stabilization, internal bracing, suture ligament augmentation, and internal brace ligament augmentation were used. Study Design: Clinical review. Level of Evidence: Level 5. Results: No exact consensus exists on effective rehabilitation protocols after ACL repair techniques, as the variation in published protocols seem even greater than the variation in those for ACLR. For some techniques such as internal bracing and dynamic interligamentary stabilization, it is likely permissible for the patients to progress to full weightbearing and discontinue bracing sooner. However, caution should be applied with regard to earlier return to sport than after ACLR as to minimize risk for retear. Conclusion: More research is needed to address how physical therapies must adapt to these innovative repair techniques. Until that is accomplished, we recommend that physical therapists understand the differences among the various ACL surgery techniques discussed here and work with the surgeons to develop a rehabilitation protocol for their mutual patients. Strength of Recommendation Taxonomy (SORT): C.

scholarly journals Treatment of Acute Proximal Anterior Cruciate Ligament Tears—Part 2: The Role of Internal Bracing on Gap Formation and Stabilization of Repair Techniques

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989742 ◽  
Author(s):  
Samuel Bachmaier ◽  
Gregory S. DiFelice ◽  
Bertrand Sonnery-Cottet ◽  
Wiemi A. Douoguih ◽  
Patrick A. Smith ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Analysis Of Covariance ◽  
Gap Formation ◽  
Acl Repair ◽  
Peak Loads ◽  
Internal Bracing ◽  
Internal Brace ◽  
Anterior Cruciate ◽  
Repair Techniques

Background: The latest biomechanical studies on some form of internal bracing have shown improved stabilization for anterior cruciate ligament (ACL) repair, but gap formation and load-sharing function have not yet been reported. Hypothesis: Internal bracing of an adjustable ACL repair construct provides improved stabilization with reduced gap formation and higher residual loading on the ACL. Study Design: Controlled laboratory study. Methods: Internally braced ACL repair constructs with single– and double–cinch loop (CL) cortical buttons, a knotless suture anchor, and a single-CL cortical button with adjustable loop fixation (CLS-ALD) were tested (n = 20 each) in a porcine model at 4 different loads (n = 5 each) over 4000 cycles at 0.75 Hz (n = 80 total). The CLS-ALD technique allowed for additional preconditioning (10 cycles at 0.5 Hz). Test results of the isolated internal brace groups served as a baseline for comparison. Lastly, specimens were pulled to failure (50 mm/min) with a cut internal brace. Final loading and gap formation on the ACL repair construct as well as ultimate strength were analyzed. Results: A statistical significance for peak loads over peak elongation was found between the CLS-ALD and all other reinforced groups (analysis of covariance, P < .001). Accordingly, the adjustable repair technique showed improved load-bearing capability with the internal brace compared with all other fixed repair groups and revealed significantly higher loads than the knotted single-CL group. Also, significantly reduced gap formation was found for the CLS-ALD compared with all other groups ( P < .001), with no gap formation up to 150 N with a final gap of 0.85 ± 0.31 mm at 350 N. A significantly higher ultimate failure load (866.2 ± 104.0 N; P < .001) was found for the button-fixed internal brace group compared with all other groups. Conclusion: Internal bracing had a crucial role in improving the stabilization potential of ACL repair at loads occurring during normal daily activity. The added strength of the internal brace allowed for reducing peak loads on the ACL repair construct as well as restricting gap formation to below 3 mm at loads up to 350 N. Clinical Relevance: Improvements in the mechanical characteristics of current ACL repair techniques that enable reduced gap formation and allow for early range of motion and accelerated rehabilitation may strengthen the self-healing response with the formation of stable scar tissue.

scholarly journals Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction

2019 ◽  
Vol 8 (1) ◽  
pp. e23-e29 ◽  
Author(s):  
Jean-Romain Delaloye ◽  
Jozef Murar ◽  
Thais Dutra Vieira ◽  
Adnan Saithna ◽  
Johannes Barth ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Ligament Repair ◽  
Anterolateral Ligament Reconstruction ◽  
Anterior Cruciate Ligament Repair ◽  
Anterior Cruciate
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