Prehabbing and Graft choice
Prehabbing your knee basically helps get full motion back in the knee, prevents muscle shrinking, decreases swelling, and improves overall comfort of your knee after surgery. Everyone is not comfortable after having their ACL reconstructed, but with prehabbing your knee, you will be more comfortable and will gain independence back faster after surgery. Graft choice is one of the most important decisions with all of the choices having pros and cons with them. As I write this the gold standard is BTB or bone patellar tendon bone autograft. If you are a high school, college, or professional athlete, this is the graft to get as it has the lowest retear rate. Next best are really 2a and 2b. They are the hamstring autograft and quad tendon autograft. If you are a weekend warrior (in your late 20’s/30’s/40’s) these are the grafts for you. Lastly the least stable graft is the cadaver allograft. If you are in your 50’s and active or just want to be functional, this is the graft for you.
Time based criteria vs. objective-based criteria.
Time based criteria is how long it has been since you have had surgery. Objective-based criteria are measurements on the patient. This is important that the patient meets both criteria prior to certain activities. Time based criteria is important as it takes a certain amount of time for the tissues to heal to be able to withstand the next level of activity in therapy. One of the most common questions I get are “When can I Run?” Generally speaking, if you had an autograft (graft was harvested from your own body) the ligament and bone plugs are able to withstand the forces of running at 12 weeks after surgery. However, objectively you must pass isolated and functional strength testing, have near full motion in your knee, and have little to no pain. If the patient is not able to meet both criteria, then moving onto running puts the patient at risk of injuring themselves again.
What to do once you are cleared for your sport?
Once you are discharged from physical therapy and you are wanting to return to a sport like soccer, football, basketball, ECT, then you should start with individual drills in practice in a closed environment (basically it is a predicable environment) for 1-2 weeks. Next, you return to full contact and participate in practice for 1-2 weeks. Finally, if you have had no issues with reintegrating into practice for a week or two, it’s time to return to competition. Andrew Kupper PT DPT SCS