Early Graft Healing Phase (~ weeks 0 – 4) Graft necrosis and hypocellularity Overall collagen structure is maintained 2. ACL graft is at its weakest between 6–12 weeks; No open-chain quads (between 0º–50º) for 18 weeks; No hyperextension or flexion beyond 120 º for 12 weeks; No cyclical loading for 12 weeks (e.g. *REMINDER: Remember that the actual graft strength is weakest from weeks 6-12, so use caution. https://www.knee-pain-explained.com/ACL-surgery-recovery.html Patellar graft is believed to be set by ~8 weeks; hamstring graft by ~12 weeks. As a result of this, the graft is mechanically at its weakest around 6-12 weeks post-operatively. cycling/wall slides/sit to stand/step-ups/cross trainer) No manual or unpredictable work for 12 weeks Avoid any turning, twisting or jumping activities. In all cases proper gait pattern must be 6-8 weeks, at 4-6 weeks you can perform leg ext. This is why its a risky time because you have something in there to stabilize your knee, swelling is down, ROM and function are better. (in reply to cozziew) Post #: 5. weeks post op. 1. [6,7] A study of surgeons in Italy showed a preference for hamstring autografts. The first phase can last for 6-10 weeks and is right after the graft is initially placed. I am entering the point during which my allograft is the weakest (6-12 weeks, about) so I need to be extra conscious of my movements. anti-inflammatory medications until 6 weeks after surgery. During this time you want to take it easy and may wear a brace. -> For 8-12 weeks is a good ballpark. Therefore, avoid open chain unassisted terminal knee extension that can cause shear forces & forceful anterior tibial translation. –> Takes ~18 months for them to transform to a ligament though!-> If you’ve had a meniscal repair, common with ACL pathology, you’ll want to be even more careful with knee flexion, as flexion mobilizes the meniscus. This all occurs between 6-12 weeks (hence why some surgeons prohibit certain exercises until the 12 week mark is passed) although I have heard some people refer to the 'weak' period as only lasting between 6-8 weeks. Proliferative Phase (~ weeks 4 – 12) Cellular repopulation Re-vascularization 3. 90-40 emphasizing low weight and high reps. You just need to be careful up to 8 weeks because although the bone to bone is healed the graft is @ it's weakest and you don't want to stretch it out ending with a loose joint. You may progress to weight bearing as tolerated with crutches between weeks 4 and 6 and wean the use of your crutches at 6 weeks post op. I am still having swelling in my ankle. Between 6-8 weeks, the live tissue is dying and your body is responding by building new tissue around the graft. For Hamstring and Allograft ACL’s you will be partial weight bearing with crutches for the first 4 weeks. 4 weeks vascularization of the graft is beginning, the graft is weakest & slightly necrotic at 4 to 6 weeks post op. (NOTHING FUN!!) Surgeons in the US most often use bone-patellar tendon-bone (BPTB) and 4-strand hamstring tendon autografts. Ligamentization Phase (12 wks – 12+ mos) Graft approaches normal ACL 11 Graft weakest 6 – 8 weeks … Coincidentally, people start feeling a lot better around this point and are keen to do a lot more, making this one of the highest risk times for re-rupture. Regardless of how long the weak phase lasts, it is when the graft is at its highest risk of stretching or failing. Arthroscopic reconstruction is the standard approach to treating ACL tears, but the optimum graft choice remains controversial. Physician Visit: 2nd follow up should be 5-6 weeks after surgery. Seems a bit weird they tell you to stop using the brace while the graft is the weakest, but I’m not complaining!
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