Expectations regarding return to play and knee "normalcy" following revision ACL reconstruction should be tempered by the reality that reported results are less encouraging than those following primary reconstruction.13 Fox et al observed a 28% failure rate (defined as presence of a pivot-shift or KT-1000 manual maximal side-to-side difference greater than 5 mm) in their series of 32 ACL revision reconstructions using nonirradiated, fresh-frozen BPTB allograft in which a standard, accelerated rehabilitation protocol was implemented. The exact effect of the rehabilitation variable in this series is unknown, but it is possible that a less aggressive protocol could have led to less graft attenuation. Nevertheless, the goals of postoperative rehabilitation following revision ACL reconstruction are in general the same as those following an index procedure, and it should be noted that in the Fox et al series no cases of arthrofibrosis were encountered.
The patient is protected in a hinged rehabilitation brace post-operatively and is permitted immediate range of motion as tolerated. Typically, weight bearing is also permitted as tolerated in the immediate postoperative period as long as the brace is locked in full extension. Weight-bearing restrictions may be indicated, however, if bone grafting was required.
Phases of rehabilitation proceed in standard fashion. Focus is initially on regaining quadriceps control and obtaining full active extension. Gait is protected with crutch use during this period. Once quadriceps control and full extension have been regained, typically at 4 to 6 weeks postoperatively, crutch and brace use is discontinued and focus shifts to obtaining full flexion and strengthening with closed-chain exercises. Once full range of motion and appropriate strength have been regained, typically at 3 months postoperatively, jogging straight ahead without cutting or pivoting is initiated. As strength and flexibility return, cutting, pivoting, plyometric, and sport-specific drills are gradually introduced. By 6 months postoperatively, the patient is generally allowed return to unrestricted activity with use of a custom ACL orthosis from 6 months to 1 year postoperatively.
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