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Personal Experiences ACL Repair (Cadaver/own graft)

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Im facing acl reconstruction and meniscus repair.

 

I want to hear from others regarding their reconstructed ACL using either Patella Allograft (Dead Cadaver Ligament), or Autograft (Patella Graft from own living tissue).

 

How long since the ACL Repair(Post Op)?

 

What activities are you doing?

 

Any limitations?

 

Have you torn it before?

 

And if there is anything you would have done differently now that you've been through all this?

 

 

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My acl was repaired using my hamstring tendon from same knee. After discussions with my doctor he advised against cadaver because of possibility of rejection He also advised against the patella, because the front of the knee where the patella comes from is sore for a LONG time, sometimes never even being able to kneel down on that knee. 

I'm happy with my decision. I was down for about 4-6 months. My repaired knee is equally as strong as my good knee. I had mine done about 4 years ago. I race desert here in Utah, still run a little, ride mountain bike. I do whatever I want.

Having a repaired acl never enters into the equation of what I can do or participate in.

 

No regrets.

 

Good luck with you decision!

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Mine was repaired with my patella. Mine took about 6 months for recovery, although the front of my knee was quite sore for about 2 years. I had mine done in July of 2010, and haven't had any problems as far as re-injuring it.  I race hare scrambles in SC and NC, ride standup jet skis, and ride mountain bikes. I would say my repaired knee is just as strong now, if not stronger than my other knee.

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in 2010 I had a back skiing accident and performed the following damage:

Torn ACL

Torn meniscus

Tibial Platue Fracture

 

I was schedualed for surgury two weeks after the accident. I did a patella graph. I was 25 at the time in great shape. Doctor decided to go with the patella because its a stronger graph and he knew i could recover from it. A guy I ride with at the track is a Physical Therapist and i dicided to us him for rehab. He was hard on me. He would "stalk" me on Facebook and make sure i wasent doing activities i shouldnt be. But it helped me in the end.

 

Its a tough recovery. Do not plan on doing any activities other than physical therapy for 6 months. BUT YOU WILL RECOVER. If you go and screw around before then, your back to square one. Today i do everything I did before the accident. I ski...(i dont hit terrain parks anymore but I'm ok with that), Snowmobile, and ride Dirtbikes like a mother F%$#er. I will also say it was a solid 10 months Plus until I had full strength back, i found that cycling was the best thing for me. I used my road bike or the stationary bike 3 times a week. Help so much, and its good for range of motion, which is something you will battle with.

 

last fall i fell and torn my rotator cuff. I was so bummed becuase i had to sit out this years snowmobile season...but this spring I've been riding MX twice a week and been feeling great, again, your going to be healing and need to learn to sit back and relax while your buddies are out crushing it, that was the hardest thing for me...

 

So in short:

Patella graph

Find awesome PT

cycle and hit gym hard when you can

DONT PUSH IT

 

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I have had 5 knee operations. 3 on the left knee and 2 on the right knee. The left knee first had a patella autograft and then from the hamstring and the right knee has a autograft from the hamstring. Left knee was injured in 2006 and 2007 and right knee in 2011. The hamstring graft makes your hamstring much weaker but it does not cause pain. My left knee always has pain after physical exertion and it pains where the patella graft was taken from. I ride bicycle and do offroad racing and anytime if there are any sort of jumps my knees will pain afterwards. My best advice will be to make sure you do your rehab properly.

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Thanks for sharing guys. Im leaning toward the hamstring graft. Seems like the patella pain from the harvest site last a long time. And from what ive read the hamstring graft is prooven to be as strong and stiff as patella graft or typical acl. Just takes a bit longer for ligament to integrate with bone.

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Look forward to hearing more from everybody out-there

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Ge4orce made the comment about the hamstring losing a lot of strength.  I was amazed at how weak mine was once I started therapy. I could not do a leg curl at all. It really scared me. BUT, the strength came back very fast with normal therapy and use. It feels completely normal now. Just a side note, I was about 46 years old when I had my surgery. Not quite a spring chicken anymore. Now at 50 it still feels great. 

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Look forward to hearing more from everybody out-there

Well I am only 2.5 months out but  will share my experience.

 

Had torn MCL since high school. Re-injured my knee several times since, I'm 29 now. Finally got it good snow skiing this March. Torn ACL, torn lateral and medial meniscus. If you really want to research the topic search some snow ski forums...

 

Had surgery 2 weeks after injuring. Was off the leg that whole time because my meniscus tear was a bucket tear and I couldn't really bend my knee.

 

Surgery- Hamstring graph acl replacement. Stitch up bucket tear, and removed about 20% of the side of the meniscus  because it could not be repaired(I guess). I barely had a big enough hamstring to qualify I got tiny little chicken legs naturally.

 

week 1 immobile first few days(from meniscus repair). Start rehab about day three. Stayed on pain killers. Ice nonstop.

 

week 2- getting range of motion was feeling good. Weened off of pain meds. could walk short distances without crutches

 

week 3- got set back. knee cap felt like it wasn't moving right. exercises were painful

 

week 4- still sucked but started getting better again.

 

week 5- Finally got off crutches, started improving a lot. began strengthening a little too. \

 

week 6- ditched post-op brace. Went back to work part desk job, part time on my feet. Had a pretty bad limp still. Swelling is still there but has gone down alot

 

week 7- work on getting maintaining extension. trying to get rid of limp.

 

week 8- same

 

week 9- limp finally going away. Doing about an hour and half of rehab everyday at this point. 

 

week 10-  trying to balance working it as much as I can and not over working it. If you do too much it swells up gets painful. Ride exercise bike  on days I don't have physical therapy, on top of my normal stretching/strengthening exercises. Run and do elliptical at physical therapy. Have to stay pretty aggressive to keep extension. My flexion qualifies as normal but not as good as my good knee. Knee pops and creeks a lot still. My knee cap doesn't like to slide around smooth either. Go back to the doc this friday, hope to get some news on what is going on there. My hamstring is very weak doing leg curls but is getting better. Rehab is for real. I didn't think I would have a problem with it, and I have done it religiously. It does get old...

 

As far as graph choice. I say hamstring and patella are best choices from my research, this is what I read... 

 

Patella seems best for hardcore athletes, tends to stay tighter, but that can also cause more pain down the road because of this, think arthritis. Also pain from the surgery site. Where the tissue is graft from does grow back.

 

Hamstring still very strong. About the same failure rate as patella(10%). Maybe loosens up more allowing knee to possible pop out of place for extreme athletes. Doesn't have the pain from surgery site like patella. Tissue never grows back, leg will always be a little bit weaker than other leg.

 

Allograph... meh seems like a half measure. High failure rate (25%). Ok  for less active people, probably some where between being a coper and getting it done right. Also works for repeat offenders who have already had their own bodies harvested of tissue.

Edited by ericz103

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Well I am only 2.5 months out but  will share my experience.

 

Had torn MCL since high school. Re-injured my knee several times since, I'm 29 now. Finally got it good snow skiing this March. Torn ACL, torn lateral and medial meniscus. If you really want to research the topic search some snow ski forums...

 

Had surgery 2 weeks after injuring. Was off the leg that whole time because my meniscus tear was a bucket tear and I couldn't really bend my knee.

 

Surgery- Hamstring graph acl replacement. Stitch up bucket tear, and removed about 20% of the side of the meniscus  because it could not be repaired(I guess). I barely had a big enough hamstring to qualify I got tiny little chicken legs naturally.

 

week 1 immobile first few days(from meniscus repair). Start rehab about day three. Stayed on pain killers. Ice nonstop.

 

week 2- getting range of motion was feeling good. Weened off of pain meds. could walk short distances without crutches

 

week 3- got set back. knee cap felt like it wasn't moving right. exercises were painful

 

week 4- still sucked but started getting better again.

 

week 5- Finally got off crutches, started improving a lot. began strengthening a little too. \

 

week 6- ditched post-op brace. Went back to work part desk job, part time on my feet. Had a pretty bad limp still. Swelling is still there but has gone down alot

 

week 7- work on getting maintaining extension. trying to get rid of limp.

 

week 8- same

 

week 9- limp finally going away. Doing about an hour and half of rehab everyday at this point. 

 

week 10-  trying to balance working it as much as I can and not over working it. If you do too much it swells up gets painful. Ride exercise bike  on days I don't have physical therapy, on top of my normal stretching/strengthening exercises. Run and do elliptical at physical therapy. Have to stay pretty aggressive to keep extension. My flexion qualifies as normal but not as good as my good knee. Knee pops and creeks a lot still. My knee cap doesn't like to slide around smooth either. Go back to the doc this friday, hope to get some news on what is going on there. My hamstring is very weak doing leg curls but is getting better. Rehab is for real. I didn't think I would have a problem with it, and I have done it religiously. It does get old...

 

As far as graph choice. I say hamstring and patella are best choices from my research, this is what I read... 

 

Patella seems best for hardcore athletes, tends to stay tighter, but that can also cause more pain down the road because of this, think arthritis. Also pain from the surgery site. Where the tissue is graft from does grow back.

 

Hamstring still very strong. About the same failure rate as patella(10%). Maybe loosens up more allowing knee to possible pop out of place for extreme athletes. Doesn't have the pain from surgery site like patella. Tissue never grows back, leg will always be a little bit weaker than other leg.

 

Allograph... meh seems like a half measure. High failure rate (25%). Ok  for less active people, probably some where between being a coper and getting it done right. Also works for repeat offenders who have already had their own bodies harvested of tissue.

glad your making a good recovery.... im even more convinced now that hamstring is better for me... i have massive legs, leg strength was never an issue for me... so i figure losing a bit of hammy wont hurt in the long run( i can rebuild/rehab hammy more than i can rehab the patella, you cant force bone to grow, but with right nutrition and rehab i can get musle and tendon to get stronger on the hammy)... but losing a bit of the patella on the other hand seems offly painfull as evident in everyones complaints over longterm pain(doggy style with the wify wont ever be the same, kneeling down during snowboarding to wait for a slow friend will be painfull or impossible)... my concern now is finding a good surgeon that will anchor that hammy graft real good to the bone....i have a 9-5 enginering desk job so that should give hammy graft acl  plenty of integration opportunity ...

Edited by zj4041

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Since you desire to be an ACL expert, you should take a look at an anatomy atlas an see how large the hamstring muscles are, and recognize that that muscle is effectively ablated when its tendon is stolen for an ACL graft. Moreover this muscle tendon unit that pulls the knee backward and is the natural ally of the ACL is no longer available to assist the Nuevo ACL.

1/3 of the patella tendon is harvested to reconstruct the ACL. That leaves 2/3 of the patella tendon. It is well known that the tendon will hypertrophy to it previous size and strength if the rehab is done. With the hamstring harvest, that big muscle in the thigh is no longer connected to the tibia, and a permanent strength defect is always present.

BTW, my ACLs are fine. I just fix them for a living, so I have no personal experience to relate.

Edited by DrMark
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looks like hamstring graft  might not even be an option for me yet ... met with my 3rd surgeon today and they all are saying they mostly do patella or cadaver graft.. so im not gonna push any of them to do hamstring....all of them are pushing me to do cadaver graft (prob because im 30 years old)....  2 of them  say they haven't seen one cadaver graft failure...one surgeon snowboards and has a cadaver graft on himself and hes perfectly happy with it... and the other guy says hes put cadaver graft in nba players .....the more im learning the more im undecided... these surgeons im seeing in Los Angelos are advocating cadaver graft and claiming such good success rates that im beginning to think it might be worth a gamble... if it tears again then at that point ill have no choice to go with the "gold standard"....

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looks like hamstring graft  might not even be an option for me yet ... met with my 3rd surgeon today and they all are saying they mostly do patella or cadaver graft.. so im not gonna push any of them to do hamstring....all of them are pushing me to do cadaver graft (prob because im 30 years old)....  2 of them  say they haven't seen one cadaver graft failure...one surgeon snowboards and has a cadaver graft on himself and hes perfectly happy with it... and the other guy says hes put cadaver graft in nba players .....the more im learning the more im undecided... these surgeons im seeing in Los Angelos are advocating cadaver graft and claiming such good success rates that im beginning to think it might be worth a gamble... if it tears again then at that point ill have no choice to go with the "gold standard"....

 

A few things to keep in mind. Surgeons are trying to get your business, that is how they make money. Of course they are going to promote whatever type of surgery they do. I would take it as a fact that allografts have higher failure rates. I am sure some surgeons are better than others, but the overall fail rates I quoted seem to be commonly accepted across different web sites. This Mayo clinic article references a study of young males, where they were 7.7 times more likely to have a fail allograph vs. the autograph failures. 

 

http://www.mayoclinic.org/medical-professionals/clinical-updates/orthopedic-surgery/anterior-cruciate-ligament-reconstruction-graft-selection

 

Also, professional athletes choices doesn't mean they are going to be the best for you. Davi Millsaps just had a synthetic acl replacement, and it is so bad that it is outlawed in the USA. Professional athletes may be making their choices based on the desire for an early return date... An allograph has an easier rehab associated with it because it didn't pull any ligament from you. 

 

I think there is probably an ideal patient for every type of surgery, you just have to figure out where you belong. Here is another good website for graft choices.

 

http://www.orthoassociates.com/SP11B35/

 

And finally, for the record, I have no medical background, and no care what you do. I'm just a dude with a couple bum knee's who did a lot of research when his time came to get one fixed. Trying to share the knowledge cause torn ACLs suck. I have yet to do it doggy style since.

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Dr. Mark, that study shows:

Patellar ACL Graft:  69 failures out of 3428 ops = 2.0%

Hamstring ACL Graft: 362 failures out of 9215 ops = 3.9%

 

going from 2 to 4 ...thats double the chances of failure.... scaryy right...

 

i look at it this way...its like saying 96% vs 98% success rate... both are pretty high up there the way i look at it.. that extra 2% isnt worth all that pain in the knee... might be... for a professional athlete .. along with the faster recovery time (with bone to bone healing) to get back in the sport... a 9-5 desk job guy like me cant spend 2-6 hours a day rehabing a knee like the gladiators do..

Edited by zj4041

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That the difference between you and me. In my experience, I am always prepared for the toast to fall butter side down. Some folks believe it always fall butter side up. Typically, they also believe in Peter Pan and the Easter bunny. Having said that, its always better to be lucky than smart.

As far as painful rehab is concerned it all depends on who holds the knife. My patients who have PT grafts, all walk out of the hospital without crutches, and have full motion of the knee before the end of the first week. On t his subject good luck is off the table.

As serious athletes, they all go to the gym anyway. I do legs a

couple of times per week. If I was working out a reconstructed knee, I wouldn't be doing anything different.

Edited by DrMark

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That the difference between you and me. In my experience, I am always prepared for the toast to fall butter side down. Some folks believe it always fall butter side up. Typically, they also believe in Peter Pan and the Easter bunny. Having said that, its always better to be lucky than smart.

As far as painful rehab is concerned it all depends on who holds the knife. My patients who have PT grafts, all walk out of the hospital without crutches, and have full motion of the knee before the end of the first week. On t his subject good luck is off the table.

As serious athletes, they all go to the gym anyway. I do legs a

couple of times per week. If I was working out a reconstructed knee, I wouldn't be doing anything different.

 

ok i get it... Good Surgeon+ Proven Technique = Near Flawless Results

 

...now a question about the alternative...(i know im trying to be optimistic here, for the sake of the less invasive approach)

 

Is there such a thing as a Better/Stronger Allograft?

 

is it possible for the surgeon to pick out a thicker (like going to a butcher..lol) , healthier looking tendon, that could result in an ACL strength equivalent to the natural acl?

 

i understand there is a whole revulcanizaiton process that has to occur to anchor in the bone caps ( which takes longer time ) ... but after its all revulcanized integrated ... and all gelled up as your own ....... 

 

is it true that part of the alograft acl dies or gets dissolved? 

and if thats the case would a beefier allograft make up for the loss in strength....

if not would your own body bring back to life the allograft tendon and make it stronger?

 

Dr, Mark , Thank you very much for taking the time to sharing your experiences and knowledge with all of us. its a real honorable act.

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ok i get it... Good Surgeon+ Proven Technique = Near Flawless Results

I ADMIRE YOUR PERSERVERANCE. THE ANSWERS ARE BELOW IN CAPITALS

 

...now a question about the alternative...(i know im trying to be optimistic here, for the sake of the less invasive approach) I CAN IMAGINE NOTHING MORE "INVASIVE" THAN A FAILED PROCEDURE.

 

Is there such a thing as a Better/Stronger Allograft? THE IRRIDATED ONES ARE BETTER THAN THE NON IRRADIATED ONES. BUT

NEITHER HOLD UP TO PUTTING YOUR FOOT DOWN IN A TURN, OR AN UNPLANNED GET OFF WHICH IS COMMON IN RECREATIONAL RIDERS.

I UNDERSTAND YOUR DESIRE TO DO MINIMAL HARM, AND THAT IS WHY I, USUALLY USE AN "ALLOGRAFT" THAT I HARVEST FROM THE OPPOSITE KNEE.

SINCE ITS ALIVE, ISOGENETIC, AND IT IS AS STRONG AS CAN BE. I WOULN'T SUGGEST THAT TO YOU, BECAUSE OF YOUR PRECONCIEVED IDEAS, BUT THAT IS THE WAY I HAVE REPAIRED SEVERAL THOUSAND OFF ROAD MOTORCYCLIST'S ACLS.

 

is it possible for the surgeon to pick out a thicker (like going to a butcher..lol) , healthier looking tendon, that could result in an ACL strength equivalent to the natural acl? QUALITY CONTROL IS ALWAYS AN ISSUE. WHEN THE DOCTOR DOES AN ALLOGAFT, HE/SHE GETS THE ONE THE CAME IN THE PACKAGE. IF YOUR SURGEON DOENS'T LIKE WHAT HE OPENED, ITS TOUGH SH1T ON HIM, AND YOU. SORRY, BUT WE ARE NOT AT WHOLE FOODS.

 

i understand there is a whole revulcanizaiton process that has to occur to anchor in the bone caps ( which takes longer time ) ... but after its all revulcanized integrated ... and all gelled up as your own ....... AS I SAID EARLIER IN THIS THREAD, YOU HAVE TO BE LUCKY. I, ALWAYS TRY TO REMOVE AS MUCH LUCK AS POSSIBLE FROM THE EQUATION.

 

is it true that part of the alograft acl dies or gets dissolved?  THE ALLOGRAFT DOESN'T DIE. ITS ALL READY DEAD

and if thats the case would a beefier allograft make up for the loss in strength.... LOL, YOU DON'T GIVE UP, DO YOU?

if not would your own body bring back to life the allograft tendon and make it stronger?

 

Dr, Mark , Thank you very much for taking the time to sharing your experiences and knowledge with all of us. its a real honorable act.

MAYBE YOU SHOULD BE A BIT KINDER TO YOURSELF AND COME VISIT ME FOR A WEEK. WE CAN MAKE THE SHORT TERM RECOVERY EASIER AND FASTER

THAN AN ALLOGRAFT, RECONSTRUCT THE "NEW KNEE LIGAMENT" (WHICH REALLY ISN'T NEW, ANYWAY) NEVER USE CRUTCHES, HAVE FULL ROM FROM THE GET GO, GO BACK TO WORK LIKE A NORMAL PERSON IN ONE WEEK, DO YOUR OWN' REHAB AT THE GYM, RETURN TO SPORTS AT THREE MONTHS, AND HAVETHE LOWEST INCIDENCE OF GRAFT FAILURE REPORTED.

Edited by DrMark

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3 1/2 weeks out on an ACL / meniscus repair. Dr. used my hamstring tendon vs. patella and I was good with that since I do spend some time crawling around at my job. My recovery is pretty similar to what others have said. First two days were the worst - getting over the nerve block and side effects of the anti nausea meds (very blurry vision). Started therapy on third day. Strength and flexibility are coming back pretty quick. Didn't walk until my 3 week checkup, got a walking brace and 3 days later I'm walking a little over 2 miles and it's not too bad. Mainly calf muscle gets pretty sore but knee feels really good. Doing therapy 3 days a week and I really like the guys doing it. Pain has been minimal throughout and so far I'm happy with everything. I chose my doctor by asking friends. Fortunately (or unfortunately) he had done ACL's on two of them and both of them were happy with him and his results. Clay

Edited by nuity5

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Thanks for sharing guys. Im leaning toward the hamstring graft. Seems like the patella pain from the harvest site last a long time. And from what ive read the hamstring graft is prooven to be as strong and stiff as patella graft or typical acl. Just takes a bit longer for ligament to integrate with bone.

Perhaps I'm just tougher than most, but I didn't experience any particular patellar discomfort from the harvest site. I had contralateral patellar graft because that's what dr mark recommends if it's feasible. I was riding my bicycle (easy dirt roads with the dogs) a few days later, and back on my dirtbike after 5 weeks, but riding fun singletrack carefully. It took 3-4 months before I really had the strength and confidence to ride hard and risk tipping over. 3 years later i ride motorcycles, play hockey, trail run, ski and essentially do everything I ever could do.

 

Read dr mark's post above. it is 100% true, at least in my case (50 yr old active male). No crutches, back to work in a week, return to full activity in 3 months.

 

The local doc that diagnosed my knee initially recommended allograft for more sedentary people, patellar autograft for athletes. He himself had an allograft but recommended I go with the better stronger way, even tho it results in a little more discomfort the first week or two.

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