17Primary ACL Reconstruction utilising The Quadriceps Tendon: The Forgotten graft?Systematic Review ofPrimary ACL Reconstruction utilisingAutograft Quadriceps TendonAnterior knee pain 10 vs 35%(BTB)3% failure rateS Hutchinson, J Mulford
18Quads Tendon Pros Cons Strong graft Good for revision graft May be useful for double bundleMay have less morbidity then Patella and hamstringsConsQuads weaknessAnterior knee painNot commonly used18
19AllograftAllograft significantly lower normal stability rates than autograftAllograft abnormal stability rate 3 times greater than autograft.The graft failure rate was /- 0.5 per 100 for autograft reconstructions /- 2.1 per 100 allograft reconstructions19
20Artificial Graft Have been used for over 30years Avoids the donor site morbidity, quicker recovery, cheat biology.Problem has been their durability – they have not matched autograft in this regard.20
28Correspondence Dr Nicolas Duval Best results are in early ACL repair augmented by LARSExpect 80 to 90% good results at 10 years.Chronic ACL tear - 50% failure at 10 yearsRevision ACL surgery - 40% failure at 10 years.
32The future – Scaffolds and Growth Factors with Repair. tissue engineering techniquesGrafts that regenerate a mechanically robust and natural ACLcell-specific growth factors that influencing the maturation and healing response of ligament tissue will also be available.32
34Patient Specific Approach Choose graft that matches the patients needs.Discuss the pros and cons of each graft.
35Rehabilitation CPM – no substantial advantage Weight bearing – standard practicePost op bracing – not necessary
36Neuromuscular stimulation – high-intensity early post-op period Neuromuscular stimulation – high-intensity early post-op period. Not required to achieve successful outcome.Accelerated rehab - minimal evidence for safe return to sport.
37Closed vs Open Closed chain safe Concern open chain results in increased laxityOpen chain excercises from 6 weeks may be safe and improve patient outcome (Mikkelsen)Glass – systematic review