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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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.
Quad Graft Recovery Is Unpredictable
- Quad tendon grafts often show variable quad activation and higher rates of cyclops lesions due to larger graft size.
- When quad shutdown occurs it can take up to a year or more to recover strength and return-to-sport timelines lengthen.
Use Multimodal Tools For Quad Inhibition
- Use pre-focal cooling, TENS, NMES and BFR to combat arthrogenic muscle inhibition and boost quad output.
- Prioritize these modalities before strength testing when quad activation is poor to reveal true capacity.