The E3 Rehab Podcast 229. ACL Graft Types w/ Nathan Henderson
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Dec 2, 2025 In this engaging discussion, Nathan Henderson, an outpatient sports and orthopedic physical therapist at Build Physio, delves into the intricacies of ACL grafts. He contrasts autografts and allografts, focusing on their pros and cons for athletes. Nathan explores the resurgence of quad tendon grafts and the unique rehab considerations for different types, including bone-patellar-tendon-bone and hamstring grafts. He also shares insights on testing approaches and rehab timelines, emphasizing the importance of patient education on graft maturation.
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Autograft vs Allograft Tradeoffs
- Autografts come from the patient's own tissue while allografts use cadaver tissue and avoid donor-site morbidity.
- Allografts rehab easier for strength but carry higher biological failure and are avoided in young athletes.
Manage Patellar Graft Like Tendinopathy
- Treat patellar tendon graft sites like patellar tendinopathy using graded loading and symptom thresholds.
- Allow 2–4/10 pain during loading if it settles by session end or next day and doesn't worsen over time.
Scale Early Quad Loading Carefully
- Avoid maximal early isometrics after patellar bone-plug harvest and use longer low-intensity holds instead.
- Use blood flow restriction and NMES to build quad activation while protecting the patellar bone plug.