Does the graft donor site in Anterior Cruciate Ligament (ACL) reconstruction affect return to sport time?

From the Guidelines

The graft donor site in Anterior Cruciate Ligament (ACL) reconstruction can affect return to sport time, with patellar tendon grafts potentially allowing for earlier return due to stronger initial fixation and faster bone-to-bone healing, as suggested by the general principles of graft healing 1. When considering the impact of the graft donor site on return to sport time, several factors come into play, including the type of graft used, the patient's overall health, and their adherence to the rehabilitation protocol.

• The type of graft used can influence the recovery timeline, with patellar tendon grafts often associated with faster recovery times compared to hamstring tendon grafts, although this is not explicitly stated in the provided evidence 1, 2.
• The rehabilitation protocol plays a crucial role in determining return to sport time, with early mobilization and specific exercises shown to improve outcomes without compromising knee laxity or stability 1.
• Key milestones in rehabilitation, such as return to running and return to training/activity, are critical, but there is limited evidence on the best progression or discharge criteria to use 2. Some important considerations for rehabilitation after ACL reconstruction include:
• Early mobilization can improve early phase knee flexion and extension range of motion without compromising knee laxity, regardless of the graft type used 1.
• Isometric quadriceps exercises can be safely prescribed during the first 2 postoperative weeks and confer advantages for faster recovery of knee range of motion without compromising stability 1.
• Starting leg press at 3 weeks can improve subjective knee function and functional outcomes, although no gains in strength at 4 months after surgery were noted 1. Given the current evidence, the decision on return to sport should be based on functional testing rather than time alone, considering factors such as full range of motion, adequate strength, and successful completion of sport-specific movement tests 2.

From the Research

Graft Donor Site and Return to Sport Time in ACL Reconstruction

• The graft donor site in Anterior Cruciate Ligament (ACL) reconstruction may affect return to sport time, as different graft types and donor sites can influence functional outcomes and re-injury rates 3, 4.
• A study found that graft type, including patellar tendon, hamstring, and quadriceps tendon autografts, can impact functional outcomes after ACL reconstruction, with patellar tendon grafts showing better performance in some tests 3.
• Donor-site morbidity and anterior knee problems can occur after ACL reconstruction using autografts, with patellar tendon autografts showing significant clinical, radiographic, and histologic abnormalities 2 years after harvest 4.
• The use of hamstring tendon autografts appears to cause less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts 4.
• A retrospective study found that the contralateral bone-patellar tendon graft presents no advantage over the ipsilateral graft in terms of donor site morbidity and return to activity 5.

Factors Influencing Return to Sport Time

• Time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries can all impact functional outcomes and return to sport time after ACL reconstruction 3.
• Resolving impairments, eliminating movement patterns associated with injury, and allowing sufficient time for graft healing are crucial for successful return to sport without further injury 6.
• The choice of graft and surgical technique can affect the severity of pain and donor-site morbidity, which can influence return to sport time 4.