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Patellar Tendinopathy: A Pitfall of ACL Reconstruction Rehab

ACL reconstruction is a common surgical procedure that aims to repair a torn anterior cruciate ligament (ACL) in the knee. While the surgery is successful in restoring knee stability, it often leads to a long and challenging rehabilitation period. One of the complications that can arise during ACL reconstruction rehab is patellar tendinopathy, a condition that affects the patellar tendon, which connects the kneecap to the shinbone. In this blog post, we will discuss the causes, symptoms, and treatment options for patellar tendinopathy during ACL reconstruction rehab.

Causes:
Patellar tendinopathy can develop due to several reasons, including overuse, repetitive stress, and biomechanical imbalances. In the case of ACL reconstruction rehab, it can occur due to the following reasons:

  1. Increased stress on the patellar tendon due to altered biomechanics after surgery.
  2. Overuse of the patellar tendon during the rehabilitation exercises.
  3. Early return to sports or physical activities before the patellar tendon has fully healed.

Symptoms:
The most common symptom of patellar tendinopathy is pain in the knee, particularly in the area just below the kneecap. The pain can be sharp or dull, and it may worsen with activities that involve bending the knee, such as squatting or jumping. Other symptoms may include:

  1. Swelling and stiffness in the knee.
  2. Tenderness in the area just below the kneecap.
  3. Limited range of motion in the knee.

Treatment:
The primary goal of treating patellar tendinopathy during ACL reconstruction rehab is to reduce pain and inflammation while promoting healing of the tendon. Here are some treatment options that may be recommended:

  1. Rest and activity modification: Resting the knee and avoiding activities that exacerbate pain can help reduce stress on the patellar tendon. Your physical therapist may recommend modifying your activity level to avoid aggravating the tendon.
  2. Heavy slow resistance training: Research has shown that heavy slow resistance (HSR) training can be an effective treatment for patellar tendinopathy. HSR involves lifting weights slowly and under high tension, which can stimulate tendon healing and promote strength gains. Your physical therapist can design an HSR program tailored to your needs and goals.
  3. Eccentric exercise: Eccentric exercises involve lengthening the muscle while under tension, which can help strengthen the tendon and improve its ability to absorb force. Your physical therapist may incorporate eccentric exercises into your rehabilitation program.
  4. Manual therapy: Soft tissue mobilization, massage, and joint mobilization can be useful for reducing pain and improving mobility around the knee.
  5. Biomechanical correction: Your physical therapist may evaluate your movement patterns and identify any biomechanical imbalances that could be contributing to your patellar tendinopathy. Correcting these imbalances with targeted exercises or modifications to your movement patterns can reduce stress on the tendon.

Patellar tendinopathy during ACL reconstruction rehab can be a challenging condition, but with the right treatment, most people can recover and return to their previous level of activity. Treatment options for patellar tendinopathy during ACL reconstruction rehab focus on reducing pain and inflammation while promoting healing of the tendon through exercise and manual therapy. If you experience any symptoms of patellar tendinopathy during ACL reconstruction rehab, it’s essential to seek the help of a qualified physical therapist to develop an appropriate treatment plan.

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Factors for Optimal ACL Surgery Outcome

As a patient of Vertex, you may be considering or have already undergone ACL surgery. Understanding the evidence-based factors that can determine your optimal long-term outcome after surgery is important for your recovery and rehabilitation process.

One of the most important factors to consider is the choice of graft material for ACL reconstruction. Autografts such as hamstring tendons, bone-patellar tendon-bone, and quadriceps tendon have been shown to have better outcomes compared to allografts. Additionally, a well-structured rehabilitation protocol that focuses on regaining range of motion, strength, proprioception, and neuromuscular control is crucial for optimal long-term outcomes. Your physical therapist at Vertex can work with you to create a personalized rehabilitation plan that suits your needs.

Age, knee extension (hyperextension is optimal), cross-sectional size of the graft, associated injuries, surgical technique, and rehabilitation protocol are also important factors to consider. It is essential to have an open and honest conversation with your surgeon about these factors and how they may impact your long-term outcome.

When it comes to finding information online, it can be overwhelming to navigate through the sea of information available. At Vertex, we prioritize evidence-based practice and aim to provide you with the most up-to-date and accurate information. References used in this blog post include:

By staying informed and actively participating in your recovery process, you can increase your chances of achieving an optimal long-term outcome after ACL surgery. Our team of experts is dedicated to providing you with the highest quality care and support throughout your recovery journey.

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Understanding the Revascularization Phase After ACL Reconstruction Surgery: What You Need to Know

After ACL reconstruction surgery, the body goes through a healing process that includes a phase called revascularization. During this phase, the body forms new blood vessels in the graft used to reconstruct the damaged ACL. This helps to provide nutrients and oxygen to the graft, which is important for its successful integration into the body.

The revascularization phase typically starts around the fourth week after surgery and continues for up to 12 weeks. During this time, there is an increase in cellular activity and changes in the extracellular matrix, which leads to the lowest mechanical properties of the reconstructed ACL graft. The graft necrosis releases growth factors that stimulate cell migration, proliferation, and extracellular matrix synthesis, which results in revascularization of the graft.

During the first few weeks of the revascularization phase, patients will work on gentle range of motion exercises to keep their knee mobile and reduce swelling. They should avoid high-impact activities, such as running or jumping, and follow their rehabilitation plan closely to avoid re-injury or complications that could require additional surgeries and prolonged rehabilitation.

As the revascularization phase progresses, the physical therapist will gradually introduce more challenging exercises and activities into the rehabilitation program. Patients may also begin to work on strength training exercises to help rebuild muscle around the knee.

It’s important to be patient during the revascularization phase and not rush the healing process. Patients should follow their physical therapist’s instructions carefully and communicate any concerns or questions they may have about their rehabilitation plan.

At Vertex, we specialize in ACL rehabilitation and have years of experience helping patients recover from ACL injuries. Our team of physical therapists will work closely with you to create an individualized rehabilitation plan that is tailored to your needs and goals. We’ll guide you through each phase of the rehabilitation process, including the revascularization phase, to help you achieve a safe and successful recovery.

In conclusion, the revascularization phase is an important part of ACL rehabilitation that requires patience and adherence to a rehabilitation plan. At Vertex, we are here to help guide you through each step of the rehabilitation process and ensure that you achieve the best possible outcome.

Reference:
Sawyer GA, Anderson BC, Christiansen BA. The Revascularization Phase of Tendon and Ligament Healing and its Relationship with Fibrosis. Curr Rheumatol Rep. 2021 Feb 10;23(3):16. doi: 10.1007/s11926-021-00972-y. PMID: 33566233.

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