> I have a 16 year old son (junior in high school) who tore
> his natural ACL in October 2009 and re-tore it 10 months
> later, August 20, 2010. Both injuries occured during
> football. His surgeon did a hamstring graft the first time.
> After the reconstruction surgery last year, he had a
> complication involving the "button", which
> flipped and required a second surgery 10 days later. Then
> he was in physical therapy for 7 months and was released
> for competitive participation in sports. I have two primary
> questions about how to proceed for the second
> reconstruction of a reconstructed ACL. My son is a
> competitive football & soccer player with opportunities
> to play in college. What is the best path to follow for a
> second surgery that will allow him the best chance to be
> competitive and physically capable of playing either sport
> at the collegiate level? The second question relates to
> physical therapy. How do you know who is a "good"
> physical therapist? The first time around we used the
> physical therapy center which is associated with the
> surgeon's practice. Just wanting some feedback on how to
> handle this for the second time and want to know what
> options exist.
> Thanks! I appreciate any help provided.
It would be helpful to know the mechanisms of both of your son's ACL injuries - contact vs. noncontact. It makes a potentially large difference in the predicted outcomes of an ACL revision reconstruction.
The options are to use the patellar tendon from either knee, the quadriceps tendon, or an allograft. Allografts have an expected delay in healing and complete maturation and so, in his case, an autograft of either PT or QT would be more favorable.
In terms of therapists, a sports medicine specialist would be dealing with ACL reconstructions on a daily basis. They would understand the most advanced techniques for restoring neuromuscular control and proprioception...from the basics at first with resumption of normal walking to advanced with the use of jump/plyometric training before release to full sports activities.
It is also important that you and your son realize that the outcomes for ACL revision reconstructions are usually inferior to primary (1st time) reconstructions. This is due to a variety of reasons, but it becomes more difficult to achieve a "normal" knee after so many operations. Based on the history of his injuries (mechanisms) and many other factors, serious discussions need to be undertaken of the likelihood of a return to 2 of the most high-risk sports in terms of knee injuries.
Good luck,
SueBW
