Cat Zingano continues with the early phase of her recovery from May 28th ACL reconstruction surgery for her right knee. (I wrote a FanPost on Bloody Elbow about the mechanism of Cat's knee injury, as well as some challenges that female athletes face regarding knee injuries.) She has recently Tweeted some interesting tidbits about her recovery thus far, as well as some specifics of the surgery.
One of the early goals in recovery from ACL surgery is to regain knee range of motion, especially full knee extension. This is done through aggressive control of pain and swelling of the knee, which in turn helps to prevent quadriceps inhibition (or poor quadriceps function). The quadriceps are the muscles that must function properly to regain that full knee extension. Fast recovery of full range of motion helps to prevent arthrofibrosis (excessive scarring within the joint) and atrophy of the quads.
From the following Tweet, it is apparent that Cat has regained near full extension of her knee in the first 2 weeks of her recovery.
The heel of her right foot is almost even with the left. Laying prone with the knee off the edge of a treatment table is a common method used to assist with regaining full knee extension.
It is interesting to note that Cat chose to have a cadaver graft for replacement of her ACL. Earlier, I asked Cat via Twitter why she chose the cadaver allograft route for her surgery. Her response was somewhat unexpected.
@mmainjury I'm told the healing/pain duration is faster. Plus, I'm a doner, and I thought how I would want,when i die, to impact someone too— Alpha Cat Zingano (@CatZingano) June 14, 2013
@mmainjury Cuz honestly, I was really on the fence about Getting a cadaver ligament, I was a little creeped out. Happy now, but wanted info— Alpha Cat Zingano (@CatZingano) June 14, 2013
@mmainjury so I asked who it was from.They said all they knew was Achilles tendon of a 29y/o man from a car wreck. Knowing made it betterIDK— Alpha Cat Zingano (@CatZingano) June 14, 2013
It appears that she chose the cadaver graft for the potential to have less pain and, presumably, quicker healing when compared to the patella tendon graft. Quite honestly, the literature on benefits/complications of cadaver grafts compared to traditional patella tendon grafts is somewhat confusing. There is evidence to suggest that the cadaver allografts take longer to fully "incorporate" within the knee. This, when combined with less pain compared to the patella tendon graft, may actually lead patients to be more active earlier after surgery, and stress the healing ligament too much too soon.
I think a good lesson can be learned from Cat's response, at least for me. Medical decisions (in this case, cadaver allograft vs patella tendon autograft) are often very complicated, even for an otherwise straight-forward surgery such as ACL repair for a competitive athlete. In the past I have been too critical of an athlete's decision to use cadaver grafts, as it seemed to me that the risk of a poor outcome was greater than the benefit of a faster recovery and less pain. My lesson learned- even a seemingly simple medical decision is usually very personal. To think otherwise is selfish on my part.
1. van Grinsven, S, van Cingel REH et al. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18:1128-1144.