There are many different kinds of tissue grafts that can be used to repair a torn or ruptured anterior cruciate ligament (ACL). The bone-patellar tendon-bone (BPTB) is called the “gold standard.” It’s used the most with the best results.

The graft is made up of the middle third of the patellar tendon and a piece of bone on either end. The bone is taken at one end from the kneecap and at the other end from the lower leg bone (tibia).

This graft works well because the patellar tendon has a high strength and stiffness. The bone plugs make it possible to get a good solid hold with screws to keep it in place. The graft seems to take hold quickly.

There are a few problems with the BPTB. Some patients have pain and swelling where the graft is taken from. It can be very difficult to kneel. Other patients report numbness, most likely caused by damage to a branch of the saphenous nerve. Loss of quadriceps muscle strength and even fracture of the patella are also possible problems.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Most doctors will send you to a physical therapist who can guide you through this process. Exercises at the beginning of rehab are different from what your knee can handle later. The goal is to get as much motion back as possible without damaging the knee any further.

The healing graft is under increased strain when the knee is in the fully extended position. Closed kinetic chain exercises with the foot on the floor or other surface strain the ACL less when the hip is bent. An example of this activity would be the mini-squats often prescribed in the early phase of rehab.

High demand exercises such as the lunge can be done when the squat is deemed safe to do after ACL repair. Then comes the step-up, step-down, and sit to stand exercises. These can all done on one leg. Each one puts about the same amount of strain on the healing graft.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

There are many parts to recovery after ACL reconstruction. Rehab can move forward quickly if there aren’t any complications and the joint is mechanically stable. Your doctor and your physical therapist will help you know when the time is right to start each phase of your rehab program.

Studies show the joint’s sense of position, called proprioception, comes back slowly over the first nine to 12 months. Most rehab programs focus on balance and proprioception during this time. Strength training and flexibility are also important.

Agility training to restore functional stability comes in later phases of rehab. You probably won’t be 100 percent at six months but if all goes well, you’ll be safe to resume sports. Follow your doctor’s advice carefully for the best long-term results.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

The jury is still out on this one. We can give you the results so far. Studies show balance and strength training are important. Flexibility is also a key feature in prevention programs. Training in all three of these areas is advised for the ankle, knee, and hip.

Single-leg balance drills have been shown to decrease knee injuries in female athletes. Forward and backward motion of the joint is improved with these exercises. Side-to-side motion is not as likely to change.

The results of studies so far suggest preseason training works well for athletes at risk for ACL injury. This includes female athletes with increased forward joint motion of the tibia (lower leg) against the femur (upper leg). Team training is good, but preventing injury works best by looking at each player’s needs and providing individual training.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Dr. Ron Losee from Ennis, Montana, was the first to describe a test for ACL instability. It was called the Losee maneuver for many years. Now it’s sometimes referred to as the “pivot-shift” test.

When the test is done, the patient is asked, “Is this how your knee feels when it gives out?” The doctor doesn’t always feel a change in the knee during the test, so the patient’s report is important.

A positive pivot-shift may be a sign that surgery is needed to repair the torn ligament. There is a device that measures laxity between the two knees (a KT-2000). The results of one test usually aren’t enough to tell which patients need an operation. Tests like the pivot-shift, along with several others, are still important.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Yes. High-velocity or high-energy accidents in contact sports can cause damage to both ligaments in the knee. This can also happen in car accidents if the knee impacts the dashboard. Injuring both ligaments makes the knee very unstable. This causes problems walking and using the knee.

With this much damage, surgery is the preferred treatment. The surgeon will repair as much as possible at one time, but these are time-consuming operations. Sometimes a second surgery is needed to finish the repair. The first and most important surgery is to repair the posterior cruciate ligament and surrounding structures. These must be repaired at the same time because these tissues work together to help stabilize the knee.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.

Your doctor may be waiting for the inflammation to calm down. When a ligament is torn or partially torn, the body responds immediately to help the healing process. Sometimes this results in a lot of swelling in the area, with a loss of knee motion.

Your doctor may have you start a physical therapy program before surgery. Physical therapy is used to help reduce pain and swelling and improve knee motion and strength. Once the initial healing reaction has calmed down and you have your motion back, surgery can be scheduled. Research shows improved results when ACL surgery is postponed until these goals are achieved.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.

Not necessarily. It’s likely your friend’s ACL was severely damaged. Your doctor may have determined that your ligament was only mildly torn or stretched out. In that case, physical therapy treatments can be used to help improve your knee function.

Your doctor and physical therapist will watch to see if you get full knee motion and strength. If your pain and swelling go away and your knee feels stable and strong, you may be able to return to competition without knee surgery.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.

There are several tests physicians use to check the integrity or strength of the repaired ligament. One of these is the pivot-shift test, in which the doctor applies pressure to the lower leg just below the knee. A “tight” joint will not shift or move with this test.

Your sense that the leg is not steady or stable enough to hold you may be caused by muscle weakness. When the replacement tissue for the torn ligament is taken from below the kneecap, the quadriceps muscle on the front of the thigh may lose strength. You may need some additional strengthening exercises. Contact your physical therapist for a follow-up evaluation.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.

  The anterior cruciate ligament–or ACL–is a major stabilizer of the knee joint. When this ligament is torn, the original, damaged tendon is removed, and the knee is reconstructed with new tissue. Typically, surgeons cut a strip from the patellar tendon (below the knee) to replace the ACL. Or they may use tissue from one of the hamstring tendons along the inside of the thigh. Screws are used to attach the new tissue in the exact location of the original tendon. This procedure is typically successful. In a recent study of 200 patients, no significant medical complications developed from ACL reconstructions using the patellar tendon. In fact, 96 to 98 percent of patients said they would choose this surgery if they had to go back and do it again.

The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. For more information on this subject, visit www.zehrcenter.com.