ACL Repair & MG Treatment

What it is: The surgeon stitches the torn ends of the ligament back together instead of replacing it.

• When used: Only in select cases — typically for proximal ACL tears where the ligament has pulled away from the femur but remains in good condition.
   
• Techniques:
  Suture anchors reattach ligament to bone.
  Internal brace augmentation with strong synthetic fiber to protect healing.
   
• Pros: Preserves original tissue, faster early recovery.
   
• Cons: Higher re-tear risk in active athletes, not suitable for most mid-substance tears.

• What it is: The torn ligament is replaced with a graft.
   
• Why: ACL tissue rarely heals on its own due to poor blood supply, so reconstruction is the gold standard.
   

1. Bone–Patellar Tendon–Bone (BTB) Autograft
   • Middle third of patellar tendon with bone plugs from patella and tibia.
   • Pros: Strong, bone-to-bone healing, good for high-demand athletes.
   • Cons: Anterior knee pain, kneeling discomfort.
      

1. Hamstring Tendon Autograft
   • Semitendinosus ± gracilis tendons rolled into a graft.
   • Pros: Smaller incision, less front-knee pain.
   • Cons: Slower fixation healing, potential hamstring weakness.
      

1. Quadriceps Tendon Autograft
   • Middle of quadriceps tendon (with or without bone plug).
   • Pros: Large graft size, less anterior knee pain than BTB.
   • Cons: Possible quadriceps weakness initially.
      

• Sources: Patellar tendon, Achilles tendon, tibialis tendon.
• Pros: Shorter surgery, less pain initially, preserves patient’s own tendons.
• Cons: Slightly higher re-tear risk in younger athletes, slower graft incorporation.

• What it is: Uses a collagen scaffold soaked in the patient’s blood to bridge the torn ends and stimulate healing.
• When used: For certain complete tears in patients with good tissue quality.
• Pros: Preserves native ACL and proprioceptive fibers, less donor site morbidity.
• Cons: Newer method, not available everywhere, long-term data still emerging.
• Video on Procedure

• Combines autograft + allograft to increase size/strength of the new ACL, often for revisions or patients with small tendons.

• Performed when a previous reconstruction fails.
   
• May involve new graft type, bone grafting of tunnels, staged procedures, or addressing alignment/meniscus issues.

💡 In summary:

• Repair = keeping the original ligament (only for select tears).
   
• Reconstruction = replacing ligament (most common).
   
• Graft choice affects rehab speed, pain profile, and long-term durability.

• Goals: Reduce inflammation, improve circulation, accelerate collagen synthesis, enhance cellular ATP production.

Target areas:

1. Peri-incisional zone 
2. Patellar tendon region (often stressed post-ACLR, especially with BTB graft).
3. Hamstring insertion if HS graft used.
4. Quadriceps belly & tendon for inhibition reduction.
5. Posterior Chain Muscles to assist with pelvic alignment and ACL healing
6. Medial/lateral joint lines to improve synovial fluid dynamics.
    

Frequency:

• 2–3×/week early, taper to 1×/week as function improves.

Goals: Break down adhesions, stimulate angiogenesis, reduce chronic inflammation, and promote tendon & ligament remodeling.

When to start:

• Not before 10–12 weeks post-op, unless addressing compensatory soft-tissue issues away from graft site.
   

Target areas:

1. Patellar tendon or quad tendon (graft donor site tendinopathy).
2. Medial/lateral hamstring if graft harvested.
3. IT band & lateral retinaculum for knee tracking improvement.
4. Distal quadriceps for mobility and function.

• Reduce swelling and pain
• Activate inhibited muscles gently
• Prevent compensatory movement patterns

• Ankle pumps, gentle quad sets, heel slides
• Avoid active knee extension > 30° initially
• Encourage normal gait with crutches/walker

• Restore full knee extension
• Improve co-contraction of quads and hamstrings
• Begin closed kinetic chain activation

• Partial weight-bearing mini squats (0–45° knee flexion)
• Step-ups (low height)
• Balance exercises on stable surfaces

• Strengthen through full knee and hip ROM
• Improve dynamic joint stability
• Prepare for plyometric and agility drills

• Lunges, step-downs, squats with proper form
• Balance and proprioception on unstable surfaces
• Light hopping and lateral movements

• Restore power, agility, and neuromuscular control
• Refine co-contraction timing and sequencing
• Prevent re-injury through dynamic control
• 
  

• Sport-specific drills (cutting, pivoting, jumping)
• Plyometric training emphasizing landing mechanics
• Reactive neuromuscular control exercises