Anterior Cruciate Ligament (ACL) Reconstruction via Allograft
If you have ever injured your knee, you might be familiar with the term ACL. A torn anterior cruciate ligament (ACL) injury can bench a person for a very long time, and will most likely require surgery before rehabilitation. The ACL is found in the knee, and in order to restore function, reconstructive surgery is often required.
This surgery involves removing the torn ligament, then inserting a graft. The good news is that it’s often performed arthroscopically….which is far less invasive through small incisions.
However, there is more than one type of graft to consider; hamstring autograft, patellar autograft, and allograft. For this particular article though, we are focusing on allograft.
What is Allograft Reconstruction?
Allograft is when the tissue used for reconstruction is donor tissue, often from a cadaver. This type of reconstruction is used most often for patients that have undergone a failed ACL reconstruction, or for those who are in sports for leisure, rather than professionally. Although this tissue might not be as strong as a person’s own tissue, it can be sufficient, making it a viable option for non-professional athletes.
The Pros and Cons of Allograft
As with everything, there are both pros and cons to this type of graft. One advantage of an allograft surgery is that the time spent in surgery is much less than other grafts. This is because there is no need to spend the time removing your own tissue for use. It also means that the incisions are often smaller, which in turn could lead to a less painful post-op experience.
A con to the allograft had been a higher risk of transmitting disease. However, the technique in preparation for the graft has significantly improved, decreasing the risk. The downside to that though is that the preparation includes freeze-drying and killing the living cells, which unfortunately decreases its strength. That in itself is a good reason why a professional athlete might not consider allograft as an option.
When there is surgery, there is typically rehabilitation. With an ACL allograft, it’s no different. You will most likely be wearing a brace and crutches for the first few weeks. The brace will allow for some movement, but limit the use as it recovers.
Certain activities will be limited, or banned altogether, at least in the beginning…such as driving. Consulting with your doctor and physical therapist will help determine what your limitations are for your specific case.
Then of course, you will be facing a few months of physical therapy. This will be in stages as your knee gets stronger and the pain diminishes. Here are a few examples of what you might see during physical therapy:
Stage One (0-6 weeks):
• Hip adduction SLR
• Quad set
• Patellar mobilization
• Knee flexion (prone)
• Knee flexion (standing)
Stage Two (6-12 weeks):
• Hip extension
• Hip abduction
• Squats (without additional weight and only to a 45° angle)
• Toe raises
• Stationary bike
• Leg presses (without additional weight and only to a 90° angle)
• Proprioceptive drills
Stage 3 (8-20 weeks):
• Light running
• Jumping rope (about 20 minutes, varying the foot)
• Side steps
• Shuttle runs
Stage 4 (20+ weeks):
• Work or sport specific drills
• Running with resistance
The above are just examples of exercises you might expect in physical therapy. The type of exercise and how quickly you progress will be determined on your ability and the advice of your doctor and physical therapist.