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What is a Soft Tissue ACL Graft?

Summary of the major steps in the surgical technique:

  • General anesthesia with the patient in the supine position
  • Physical exam or diagnostic arthroscopy to document all pathology
  • Soft tissue graft harvest and/or preparation
  • Preparation of notch and takedown of leftover ACL stump
  • Tibial tunnel creation
  • Femoral tunnel creation
  • Graft passage through tibial and femoral tunnels
  • Fixation of the ACL graft in femoral tunnel
  • Fixation of ACL graft in tibial tunnel
  • Wound closure

Details and choices that may affect details of rehabilitation:

  • Surgical
    • Presence of other knee pathology:
      • Frequently, patients undergoing ACL reconstruction are noted to have other knee pathology preoperatively or at the time of diagnostic arthroscopy. These may include other ligamentous injuries, meniscus tears, or cartilage injuries. It is important to determine whether any other injuries exist or concomitant procedures were performed, as this may change post-surgical rehabilitation
    • Autograft versus Allograft Ligament Reconstruction:
      • ACL grafts may be derived from the patient’s own tissue (autografts) or cadaveric tissue (allografts). The autograft soft tissue most commonly used for ACL reconstruction is the hamstring tendons (semitendinosus and gracilis tendons—frequently a quadrupled stranded construct). However, it is becoming more common to also use an autograft quadriceps tendon. Allograft options for soft tissue ACL reconstruction include hamstring tendons, tibialis anterior tendon, and Achilles tendon grafts. It is important to know whether any autograft tendon was harvested in your patient as this may influence hamstring post-surgical rehabilitation.
    • Graft type and graft fixation
      • ACL reconstruction can be performed with a soft-tissue graft (hamstring, Achilles tendon, tibialis anterior, quadriceps) or a BoneTendon-Bone graft (patellar tendon with 2 bone plugs).
      • Accelerated rehabilitation programs, similar to those commonly used following ACL reconstructions using the patellar tendon autograft, have been shown to be equally successful following reconstruction with a hamstring graft.
      • In cases where tibial or femoral tunnel fixation of the grafts are not as strong, a slightly less aggressive rehabilitation protocol may be suggested.
      • Soft tissue-to-bone healing takes 12 weeks to complete in most instances whereas bone-to-bone healing occurs in approximately 8 weeks.
  • Anesthesia
    • Regional anesthesia, frequently in the form of a femoral nerve block, may provide excellent post-operative analgesia, leading to improved outcomes. However, the block may wear off 8-24 hours after surgery. Be cognizant of rebound pain and be quick to utilize other modalities.

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