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An increasingly common knee injury these days is a ruptured Anterior Cruciate Ligament (ACL). Over the last 5-10 years some new techniques for reconstructing this ligament have become more widely accepted. The following is some information regarding the most common types of reconstructions that are offered and how the rehabilitation differs between them.
Traditional Hamstring Graft
The hamstring graft is the most widely accepted ACL reconstruction surgery. This involves taking a portion of the hamstring tendon, and using it to reconstruct the ruptured ACL. This is a very successful surgery, however does involve a lengthy rehabilitation period and time away from sport.
There is a critical period in the rehabilitation which is created by the graft actually becoming weaker before it strengthens into the new functional ligament. This occurs around the 8 week mark post surgery and is one of the main reasons for the extensive rehabilitation period.
There also needs to be special consideration as to the donor site (where they take the hamstring tendon) as this can cause pain and dysfunction if it is not rehabilitated properly.
Rehab Milestones: Walking without crutches – Between 2-4 weeks
Return to Running – Approx. 16 weeks (requires surgeon approval)
Return to Sport – Approx. 9-12 months (requires Surgeon approval)
LARS artificial ligament
This type of graft has begun to be used more commonly over the past 5 years. Awareness of the LARS spiked dramatically when the AFL’s Sydney Swans elected to use the graft to repair Nick Malceski’s ruptured ACL. Malceski returned to playing within 4 months of surgery, and since then more players in the AFL and other codes have undergone a LARS reconstruction.
Using the LARS ligament means that from the time of surgery the graft is very strong and there is no critical period. There is also no donor site, meaning the hamstrings and other muscle groups are not impacted when there is no need to take a graft from their tendons.
The reason this type of graft is not fully accepted by all surgeons and professionals is that there is currently limited research as to their lifespan. At present the best studies are showing the LARS still functional and strong at 4-5 years post surgery, however there is limited evidence as to their condition after this time. Some professionals and specialists believe the LARS may weaken or fray, however there is no concrete evidence that this occurs either.
Rehab Milestones: Walking without crutches – approx. 1 week
Return to Running – approx. 8-12 weeks (requires surgeon approval)
Return to Sport – approx. 12-16 weeks (with surgeon approval)
Hybrid Graft (LARS and Hamstring combination)
This type of graft has been used by some surgeons and so far it looks quite promising. The main aim with the Hybrid graft is to have the early return to function that the LARS provides, with the longevity that is ensured with the Hamstring tendon graft. A recent study has found that the thickness of the graft has a strong link to preventing re-rupture, and therefore by combining the two you get a thicker graft as a result.
As the hamstring tendon is grafted, this donor site still needs to be considered during the rehabilitation. However as the LARS is at full strength from the time of surgery, there is no critical period associated with the Hybrid Reconstruction.
Rehab Milestones: Walking without crutches – approx. 1-2 weeks
Return to Running – approx. 12 weeks (requires surgeon approval)
Return to Sport – considered after 16 weeks (with surgeon approval)