PATELLOFEMORAL OSTEOARTHRITIS

those outcomes to determine how to improve treatment for knee problems. The research program has data on more than 13,000 patients.

Bray-Prescott says that two factors account for not finding a link between use of a PTG and increased incidence of patellofemoral osteoarthritis among Shelbourne Knee Center patients: postponing surgery until completion of pre-op rehabilitation and an accelerated post-op rehabilitation program.

Both pre- and post-op rehabilitation focus on eliminating or significantly reducing swelling and improving range of motion (ROM) before strengthening. Patients work with one of the Center’s physical therapists/athletic trainers.

“We emphasize range of motion. A lot of people will brace patients or limit weight-bearing after ACL reconstructions, but if patients are not getting their full extension back in the first two months, they are not going to get it back,” says BrayPrescott. “That leads to a stiff joint which leads to arthritic changes.”

Bray-Prescott and physical therapist Bill Claussen presented the study at the American Physical Therapy Association Combined Sections Meeting (February 23-25, 2023, in San Diego).

References

1. Bauman S, Claussen W, Benner RB, Shelbourne KD. Does Patellar Tendon Graft Harvest for ACL Reconstruction Lead to an Increased Rate of Patellofemoral Arthritis?

Unpublished data, 2022.

2. Shelbourne KD, Urch SE. Primary anterior cruciate ligament reconstruction using the contralateral autogenous patellar tendon. Am J Sports Med. 2000;28:651-8.

3. Shelbourne KD, Beck MB, Gray T. Anterior Cruciate Ligament Reconstruction With Contralateral Autogenous Patellar Tendon Graft: Evaluation of Donor Site Strength and Subjective Results. Am J Sports Med. 2014;43:648-53.

Solving Rehabilitation Challenges

Rehabilitation results for ACL reconstruction patients treated with PTGs are far superior to those of patients treated with hamstring and cadaver grafts, when done well. But widespread use of PTGs has been hampered by lack of understanding of how to properly rehabilitate ACL reconstructions that use PTGs.

Through its research program, Shelbourne Knee Center has developed a proven rehabilitation process that enables patients to achieve nearly full extension and flexion by two to three months post-op:

• Full extension: 98% of patients

• Full flexion: 92%.3

With hamstring and cadaver grafts, patients rarely achieve full range of motion or full strength and are left with knees that aren’t symmetric.

Pre-op Rehabilitation

Before surgery, patients work with their personal physical therapist/athletic trainer to achieve:

• Full ROM

• Little or no swelling

• Normal walking

• Appropriate strength and leg control

Post-op Rehabilitation

The accelerated ACL post-op rehabilitation protocol begins during the patient’ s 23-hour hospital stay. It includes:

• Eliminating swelling by lying down with the knee above the heart for the first seven days. Use of a Cryo-Cuff and a continuous passive motion (CPM) machine also help to eliminate swelling.

• Full extension exercises beginning the day of surgery.

• Weight-bearing is allowed as tolerated for bathroom privileges.

• Emphasis is on range of motion exercises for flexion while maintaining full knee extension.

• Strengthening exercises begin when full extension and flexion is achieved.

Patients complete most of their physical therapy at home, with guidance from their physical therapist/athletic trainer and periodic visits to Shelbourne Knee Center.