- Post-Procedure: Bone-Patellar Tendon-Bone Graft: Endoscopic
- Post-Procedure: Bone-Patellar Tendon-Bone Graft: Two-Incision
- Post-Procedure: Endoscopic Quadruple Hamstring Graft
- Post-Procedure: Transepiphyseal Replacement of Anterior Cruciate Ligament Using Quadruple Hamstring Grafts
- Post-Procedure: Physeal Sparing Reconstruction of the Anterior Cruciate Ligament
Post-Procedure: Bone-Patellar Tendon-Bone Graft: Endoscopic
POST-PROCEDURE CARE
See Table 2.
COMPLICATIONS
- See Table 2 for significant and less common problems.
- Impingement
- Signs and symptoms indicating impingement
- Loss of full extension
- Persistent effusion
- Anterior knee pain
- Clicking or popping in the anterior part of the knee that is painful with terminal extension
- Postoperative radiographs are reviewed to make sure that the tunnels are correctly placed and that an obvious impingement is not demonstrable.
- A lateral radiograph should be obtained with the knee in extension to:
- Ensure the tibial tunnel is posterior to the foot of the intercondylar notch
- Ensure screw placement in the femur is in the posterior aspect of the intercondylar notch
- Arthrofibrosis
- Treat with antiinflammatory medication and supervised therapy.
- If motion fails to progress over 4 to 6 weeks of therapy and the patient has less than 90 degrees flexion after 6 weeks of supervised physical therapy, gentle manipulation and possibly arthroscopic evaluation should be considered.
- Postoperative infections
- Uncommon with arthroscopic anterior cruciate ligament reconstructions
- Signs and symptoms indicating early infection:
- Persistence or recurrence of temperature 5 to 6 days after the procedure with increased pain
- Loss of knee motion
- Heat or erythema at the knee site
- If knee aspiration shows a white cell count to be elevated, often in the range of 20,000/ L or more, arthroscopic irrigation and evaluation of the graft should be performed.
- A combination of intravenous antibiotics for 2 to 3 weeks followed by oral antibiotics to complete a 6-week course of organism-specific antibiotic treatment is necessary.
ANALYSIS OF RESULTS
- Patellar tendon and hamstring grafts, when fixed at the joint line with secondary fixation on the tibia, have almost equal results.
- Wagner found slightly better results with a hamstring, but most studies show comparable results with newer fixation techniques.
OUTCOMES AND EVIDENCE
- Stability and failure rates
- Five-year follow-up studies of anterior cruciate ligament reconstruction using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Stiffness and strength
- Slightly better with bone-patellar tendon-bone, but overall results are comparable
- Allograft studies at 5- and 7-year follow-up are similar to those with autograft for the following reasons:
- The incidence of effusions and apparent graft rejection has decreased.
- Graft procurement and sterilization techniques have improved.
- Failure rates
- Stable at about 7% to 8% at 5-year follow-up when graft failure is the cause of the poor outcome
- Other studies measure failure by KT-1000 testing, incidence of the knee giving way, or failure of the patient to return to a previous sporting activity.
- If these parameters are used to measure surgical failure, the percentage ranges from 5% to 52%.
- Failure has important economic and emotional consequences.
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Meniscal damage has been shown to occur in approximately
- 40% at 1 year
- 60% at 5 years
- Approximately 80% at 10 years
- This is the same incidence as degenerative joint disease seen at 10 years.
Procedure: Bone-Patellar Tendon-Bone Graft: Endoscopic
Post-Procedure: Bone-Patellar Tendon-Bone Graft: Two-Incision
POST-PROCEDURE CARE
See Table 2.
COMPLICATIONS
- See Table 2 for significant and less common problems.
- Impingement
- Signs and symptoms indicating impingement
- Loss of full extension
- Persistent effusion
- Anterior knee pain
- Clicking or popping in the anterior part of the knee that is painful with terminal extension
- Postoperative radiographs are reviewed to make sure that the tunnels are correctly placed and that an obvious impingement is not demonstrable.
- A lateral radiograph should be obtained with the knee in extension to:
- Ensure the tibial tunnel is posterior to the foot of the intercondylar notch
- Ensure screw placement in the femur is in the posterior aspect of the intercondylar notch.
- Arthrofibrosis
- Treat with antiinflammatory medication and supervised therapy.
- If motion fails to progress over 4 to 6 weeks of therapy and the patient has less than 90 degrees flexion after 6 weeks of supervised physical therapy, gentle manipulation and possibly arthroscopic evaluation should be considered.
- Postoperative infections
- Uncommon with arthroscopic anterior cruciate ligament reconstructions
- Signs and symptoms indicating early infection:
- Persistence or recurrence of fever 5 to 6 days after the procedure with increased pain
- Loss of knee motion
- Heat or erythema at the knee site
- If knee aspiration shows a white cell count to be elevated, often in the range of 20,000/ L or more, arthroscopic irrigation and evaluation of the graft should be performed.
- A combination of antibiotics intravenously for 2 to 3 weeks followed by oral antibiotics to complete a 6-week course of organism-specific antibiotic treatment is necessary.
ANALYSIS OF RESULTS
- Patellar tendon and hamstring grafts, when fixed at the joint line with secondary fixation on the tibia, have almost equal results.
- Wagner in his study found slightly better results with a hamstring, but most studies show comparable results with newer fixation techniques.
OUTCOMES AND EVIDENCE
- Stability and failure rates
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Stiffness and strength
- Slightly better with bone-patellar tendon-bone, but overall results are comparable.
- Allograft studies at 5- and 7-year follow-up are similar to those with autograft for the following reasons:
- The incidence of effusions and apparent graft rejection has decreased.
- Graft procurement and sterilization techniques have improved.
- Failure rates
- Stable at about 7% to 8% at 5-year follow-up when graft failure is the cause of the poor outcome
- Other studies measure failure by KT-1000 testing, incidence of the knee giving way, or failure of the patient to return to a previous sporting activity.
- If these parameters are used to measure surgical failure, the percentage ranges from 5% to 52%.
- Failure has important economic and emotional consequences.
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Meniscal damage has been shown to occur in approximately
- 40% at 1 year
- 60% at 5 years
- Approximately 80% at 10 years
- This is the same incidence as degenerative joint disease seen at 10 years.
Procedure: Bone-Patellar Tendon-Bone Graft: Two-Incision
Post-Procedure: Endoscopic Quadruple Hamstring Graft
POST-PROCEDURE CARE
- Table 2 provides detail on appropriate post-procedure care. However, when the hamstring graft is used, the rehabilitation is typically at a slower pace.
- The patient generally is allowed to return to full activity at around 9 months.
COMPLICATIONS
- See Table 2 for significant and less common problems.
- Impingement
- Signs and symptoms indicating impingement
- Loss of full extension
- Persistent effusion
- Anterior knee pain
- Clicking or popping in the anterior part of the knee that is painful with terminal extension
- Postoperative radiographs are reviewed to make sure that the tunnels are correctly placed and that an obvious impingement is not demonstrable.
- A lateral radiograph should be obtained with the knee in extension to:
- Ensure the tibial tunnel is posterior to the foot of the intercondylar notch.
- Ensure screw placement in the femur is in the posterior aspect of the intercondylar notch.
- Arthrofibrosis
- Treat with antiinflammatory medication and supervised therapy.
- If motion fails to progress over 4 to 6 weeks of therapy and the patient has less than 90 degrees flexion after 6 weeks of supervised physical therapy, gentle manipulation and possibly arthroscopic evaluation should be considered.
- Postoperative infections
- Uncommon with arthroscopic anterior cruciate ligament reconstructions
- Signs and symptoms indicating early infection:
- Persistence or recurrence of temperature 5 to 6 days after the procedure with increased pain
- Loss of knee motion
- Heat or erythema at the knee site
- If knee aspiration shows a white cell count to be elevated, often in the range of 20,000/ L or more, arthroscopic irrigation and evaluation of the graft should be performed.
- A combination of intravenous antibiotics for 2 to 3 weeks followed by oral antibiotics to complete a 6-week course of organism-specific antibiotic treatment is necessary.
ANALYSIS OF RESULTS
- Patellar tendon and hamstring grafts, when fixed at the joint line with secondary fixation on the tibia, have almost equal results.
- Wagner found slightly better results with a hamstring, but most studies show comparable results with newer fixation techniques.
OUTCOMES AND EVIDENCE
- Stability and failure rates
- Five-year follow-up studies of anterior cruciate ligament reconstruction using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Stiffness and strength
- Slightly better with bone-patellar tendon-bone, but overall results are comparable.
- Allograft studies at 5- and 7-year follow-up are similar to those with autograft for the following reasons:
- The incidence of effusions and apparent graft rejection has decreased.
- Graft procurement and sterilization techniques have improved.
- Failure rates
- Stable at about 7% to 8% at 5-year follow-up when graft failure is the cause of the poor outcome
- Other studies measure failure by KT-1000 testing, incidence of the knee giving way, or failure of the patient to return to a previous sporting activity.
- If these parameters are used to measure surgical failure, the percentage ranges from 5% to 52%.
- Failure has important economic and emotional consequences.
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Meniscal damage has been shown to occur in approximately
- 40% at 1 year
- 60% at 5 years
- Approximately 80% at 10 years
- This is the same incidence as degenerative joint disease seen at 10 years.
Procedure: Endoscopic Quadruple Hamstring Graft
Post-Procedure: Transepiphyseal Replacement of Anterior Cruciate Ligament Using Quadruple Hamstring Grafts
POST-PROCEDURE CARE
Rehabilitation must be geared to the age of the young patient.
COMPLICATIONS
- See Table 2 for significant and less common problems.
- Impingement
- Signs and symptoms indicating impingement
- Loss of full extension
- Persistent effusion
- Anterior knee pain
- Clicking or popping in the anterior part of the knee that is painful with terminal extension
- Postoperative radiographs are reviewed to make sure that the tunnels are correctly placed and that an obvious impingement is not demonstrable.
- A lateral radiograph should be obtained with the knee in extension to:
- Ensure the tibial tunnel is posterior to the foot of the intercondylar notch
- Ensure screw placement in the femur is in the posterior aspect of the intercondylar notch.
- Arthrofibrosis
- Treat with antiinflammatory medication and supervised therapy.
- If motion fails to progress over 4 to 6 weeks of therapy and the patient has less than 90 degrees flexion after 6 weeks of supervised physical therapy, gentle manipulation and possibly arthroscopic evaluation should be considered.
- Postoperative infections
- Uncommon with arthroscopic anterior cruciate ligament reconstructions
- Signs and symptoms indicating early infection:
- Persistence or recurrence of temperature 5 to 6 days after the procedure with increased pain
- Loss of knee motion
- Heat or erythema at the knee site
- If knee aspiration shows a white cell count to be elevated, often in the range of 20,000/ L or more, arthroscopic irrigation and evaluation of the graft should be performed.
- A combination of antibiotics intravenously for 2 to 3 weeks followed by oral antibiotics to complete a 6-week course of organism-specific antibiotic treatment is necessary.
ANALYSIS OF RESULTS
- Patellar tendon and hamstring grafts, when fixed at the joint line with secondary fixation on the tibia, have almost equal results.
- Wagner found slightly better results with a hamstring, but most studies show comparable results with newer fixation techniques.
OUTCOMES AND EVIDENCE
- Stability and failure rates
- Five-year follow-up studies of anterior cruciate ligament reconstruction using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Stiffness and strength
- Slightly better with bone-patellar tendon-bone, but overall results are comparable.
- Allograft studies at 5- and 7-year follow-up are similar to those with autograft because of the following:
- The incidence of effusions and apparent graft rejection has decreased.
- Graft procurement and sterilization techniques have improved.
- Failure rates
- Stable at about 7% to 8% at 5-year follow-up when graft failure is the cause of the poor outcome
- Other studies measure failure by KT-1000 testing, incidence of the knee giving way, or failure of the patient to return to a previous sporting activity.
- If these parameters are used to measure surgical failure, the percentage ranges from 5% to 52%.
- Failure has important economic and emotional consequences.
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Meniscal damage has been shown to occur in approximately
- 40% at 1 year
- 60% at 5 years
- Approximately 80% at 10 years
- This is the same incidence as degenerative joint disease seen at 10 years.
Procedure: Transepiphyseal Replacement of Anterior Cruciate Ligament Using Quadruple Hamstring Grafts
Post-Procedure: Physeal Sparing Reconstruction of the Anterior Cruciate Ligament
POST-PROCEDURE CARE
- Touch-down weight bearing is allowed for 6 weeks.
- Immediate mobilization from 0 to 90 degrees is allowed for the first 2 weeks.
- Continuous passive motion from 0 to 90 degrees is used for the first 2 weeks postoperatively.
- A protective hinged knee brace is used for 6 weeks after surgery.
- Use motion limits of 0 to 90 degrees for the first 2 weeks.
- Progressive rehabilitation consists of:
- Range-of-motion exercises
- Patellar mobilization
- Electrical stimulation
- Pool therapy (if available)
- Proprioception exercises
- Closed-chain strengthening exercises during the first 3 months postoperatively followed by straight-line jogging
- Polymetric exercises
- Sport cord exercises
- Sport-specific exercises
- Return to full activity, including sports that involve cutting, usually are allowed at 6 months postoperatively.
- A custom-made knee brace is used routinely during cutting and pivoting activities for the first 2 years after the return to sports.
COMPLICATIONS
- Impingement
- Signs and symptoms indicating impingement
- Loss of full extension
- Persistent effusion
- Anterior knee pain
- Clicking or popping in the anterior part of the knee that is painful with terminal extension
- Postoperative radiographs are reviewed to make sure that the tunnels are correctly placed and that an obvious impingement is not demonstrable.
- A lateral radiograph should be obtained with the knee in extension to:
- Ensure the tibial tunnel is posterior to the foot of the intercondylar notch
- Ensure screw placement in the femur is in the posterior aspect of the intercondylar notch.
- Arthrofibrosis
- Treat with antiinflammatory medication and supervised therapy.
- If motion fails to progress over 4 to 6 weeks of therapy and the patient has less than 90 degrees flexion after 6 weeks of supervised physical therapy, gentle manipulation and possibly arthroscopic evaluation should be considered.
- Postoperative infections
- Uncommon with arthroscopic anterior cruciate ligament reconstructions
- Signs and symptoms indicating early infection:
- Persistence or recurrence of temperature 5 to 6 days after the procedure with increased pain
- Loss of knee motion
- Heat or erythema at the knee site
- If knee aspiration shows a white cell count to be elevated, often in the range of 20,000/ L or more, arthroscopic irrigation and evaluation of the graft should be performed.
- A combination of intravenous antibiotics for 2 to 3 weeks followed by oral antibiotics to complete a 6-week course of organism-specific antibiotic treatment is necessary.
ANALYSIS OF RESULTS
- Patellar tendon and hamstring grafts, when fixed at the joint line with secondary fixation on the tibia, have almost equal results.
- Wagner found slightly better results with a hamstring, but most studies show comparable results with newer fixation techniques.
OUTCOMES AND EVIDENCE
- Stability and failure rates
- Five-year follow-up studies of anterior cruciate ligament reconstruction using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Stiffness and strength
- Slightly better with bone-patellar tendon-bone, but overall results are comparable.
- Allograft studies at 5- and 7-year follow-up are similar to those with autograft for the following reasons:
- The incidence of effusions and apparent graft rejection has decreased.
- Graft procurement and sterilization techniques have improved.
- Failure rates
- Stable at about 7% to 8% at 5-year follow-up when graft failure is the cause of the poor outcome
- Other studies measure failure by KT-1000 testing, incidence of the knee giving way, or failure of the patient to return to a previous sporting activity.
- If these parameters are used to measure surgical failure, the percentage ranges from 5% to 52%.
- Failure has important economic and emotional consequences.
- Five-year follow-up studies of anterior cruciate ligament reconstruction, using autograft bone-patellar tendon-bone grafts and hamstring grafts show similar results.
- Meniscal damage has been shown to occur in approximately
- 40% at 1 year
- 60% at 5 years
- Approximately 80% at 10 years
- This is the same incidence as degenerative joint disease seen at 10 years.
Procedure: Physeal Sparing Reconstruction of the Anterior Cruciate Ligament
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