ACLR ACL Reconstruction in the Professional Or Elite Athlete

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The decision of which grafts to use during ACLR ACL reconstruction in the professional or an elite athlete depends on the sports that the patient plays and his/her previous ACLR. It is essential to take these factors into consideration to ensure the best results. Here are some tips to improve your recovery and prevent future injury. ACLR is a major surgery, with high rates of reinjury. Fortunately, there are effective surgical techniques to minimize the risk of reinjury.

Anatomical single-bundle reconstruction with quadriceps tendon autograft of the left knee

Anatomical single-bundle reconstruction of the left knee with quadriceps tendon autografted ligaments is a highly effective treatment for traumatic injuries in this type of patient. It is effective for patients with severe instability, giving out during activity, or pain on clinical examination. Patients can expect good to excellent long-term results.

Anatomical single-bundle reconstruction of the left knee in the professional or elite athletes involves replacing a failed quadriceps tendon with a functional one. During the procedure, the surgeon passes an anteromedial graft through the damaged quadriceps tendon and secures it using suture or bone-plug-fixation. This procedure enables the knee to heal fully and is preferred over other surgical techniques.

Aims to return the knee to 90 degrees of flexion are the first steps in the rehabilitation process. The patient should begin active exercises within two to four weeks. By six weeks, patients should be able to perform full-knee extension without pain. In the first 14 days, patients should not exercise too much, although they can perform simple exercises such as squatting.

After confirmation of the anterior cruciate ligament tear, the graft is harvested. An eccentric drilling technique is used to tunnel the tibial and femoral tunnels. An Ethibond suture is passed through the femoral tunnel. The graft is pulled down with an Ethibond suture from the guidewire.

High rates of reinjury after ACLR ACL reconstruction

The high rates of reinjury after ACLR ACR reconstruction in elite athletes raise important questions about the surgical techniques and rehabilitation protocols used. While a complete recovery from ACL surgery is desirable, some factors contribute to reinjury. For example, an athlete's quadriceps strength may be unbalanced, which can cause compensatory movement patterns. Moreover, athletes who do not fully recover from ACL surgery may mask their deficiency during functional tests.

Previous studies have found no significant differences between the two groups for return to sport and second ACL injury outcomes. However, these studies did not consider time delays following ACL surgery and subsequent return to sport. Future research should consider the possible consequences of such time delays. Additionally, the selection of an appropriate training program and strict return-to-sport criteria should be considered to reduce the risk of secondary ACL injury.

After ACLR ACL reconstruction, 95% of athletes returned to their sport at some level. However, one athlete did not meet the criteria for return to sport after five to seven years. The athlete cited lifestyle changes and not enough time as reasons for not returning to sport. In general, a high rate of reinjury after ACLR ACL reconstruction is not an indication for undergoing this surgery.

Rehabilitation after ACLR ACL reconstruction

An early return to sport training program is critical to the success of ACL surgery, and the return to athletic activity should be planned carefully to optimize athletic performance. The early rehabilitation phase involves early physiotherapy care, and gym-based physical preparation involving isometrics, jump-landing preparation, dynamic strength training, and blood-flow restriction resistance exercise. Typically, this phase of rehabilitation should last six to nine months, and includes sports-specific reconditioning.

The first step in ACLR rehabilitation is to determine the patient's postoperative goals and performance level. The aim should be to achieve RTS on par with the athlete's previous level. Anatomically individualised ACLR has improved outcomes, but larger studies are required to determine the efficacy of current techniques. Quadriceps tendon autograft and lateral extra-articular tenodesis procedures are two emerging options.

To evaluate the effectiveness of rehabilitation, strength diagnostic tests should be performed. The tests should measure the willingness of the athlete to fully load the joint. The athlete should also be able to accelerate and decelerate without falling. The rehabilitation program should also include sport-specific elements, such as reactive agility exercises and dual tasks that are not measured in the clinical tests. This way, the athlete can make informed decisions regarding the rehabilitation program.