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Recent ACL tear...

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Renes, is your doctor taking November and December off because he/she has all ready done his/her alloted operations for the year and the system will not pay him/her for any further work?

Well, if that is the case then that is news to me. I have never heard that before. This doctor has a very good reputation and I had heard that he works like a trojan. So I just assumed that he works hard all year just so he can take off more time. Hmmm. Well, when I see him in a couple weeks I'll ask him straight out. I'm sure he'll educate me more on our health system. I doubt it's a secret. I will let you know what he says.

Forty dollars per month, or 400 dollars per month? Both are a small price to pay for having a leg that works, no?

LOL, yes this is very true. But I guess given the choice I'd prefer the $40.

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I just had a cadaver graft done on my right knee. The first week and a half was the most uncomfortable time ever. Being in the military I need to run and jump so the autograft did not seem to be the better choice. I ride off road but only trail riding and my tires usually stay on the ground.

For those of you that have had this procedure what should I expect in the next two weeks?

Thanks

Eric

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Eric, your leg should get gradually less painful and your gait should improve in these next weeks. You should be on the stationary bike one hour per day every day.

Cadaver grafts go in easy, but fail easy too. You can't ride MX for at least a year, and I don't think that you can be fit for active duty for a year.

If your are a MXer, the first time you put that foot down, if in the first year, that graft is toast. Be careful, and keep your cardio up for when you finally can ride.

A year is a long time to be away from what you love. That why I never put i cadaver tissue into athletes. With the opposite patella tendon, my guys ride at three months.

Good luck

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If your are a MXer, the first time you put that foot down, if in the first year, that graft is toast.

sorry I'm new to this. what do you mean by "put that foot down".

thanks,

atek3

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On a turn one may take their foot off the peg. If it hits the dirt, and the bike is moving the graft will tear, not to mention a bad get off.

That is why if you have a cadaver graft which is dead, you MUST stay off the bike for ONE YEAR until it can be replaced with strong, living tissue.

That the reason that I use the opposite patella tendon for ACL reconstructions. It has all the advantages of the cadaver graft, but it is alive and comes from the same guy. That knee is ready for MX in three months.

The donor knee recovers in about the same time with the perscribed strengthening exercises.

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drmark,

If someone with a cadaver graph stays off the bike for a year and does the pt have you seen any problems with the graph?

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Well you have to refrain from any and all sports except cycling for a year. Can you or do you want to do that? Most MXer don't.

I have put two kids through private school revisiing cadaver grafts to autografts. Most all of those athletes thought they were getting off easy the first time. Then they had to do it again.

All the Houston MX pros have had allografts, and then relatively trivial injuries which cause the graft to fail. Doctors are stupid and they don't understand MX. Why any MXer would have an allograft is is question that I will never have an answer for. Here are to important links

http://sandersclinic.net/common_salvageacl.html

http://sandersclinic.net/common_antercruciate.html

read the text, view the illustrations, the FAQs, and read the testimonials.

If you are in the military, find out what other options your doc will offer you

At this point in my life I would probably have one or two stars if I had selected a military career and I would have anyone under my command court martialed if they did a cadaver graft on a guy under fourty, or any high demand athlete.

Thats my story and I'm sticking to it.

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Well you have to refrain from any and all sports except cycling for a year. Can you or do you want to do that? Most MXer don't.

I have put two kids through private school and paid off two ex wives revisiing cadaver grafts to autografts. Most all of those athletes thought they were getting off easy the first time. Then they had to do it again.

All the Houston MX pros have had allografts, and then had relatively trivial injuries which cause the graft to fail. Doctors are stupid and they don't understand MX. Why any MXer would have an allograft is is question that I will never have an answer for. Here are to important links

http://sandersclinic.net/common_salvageacl.html

http://sandersclinic.net/common_antercruciate.html

read the text, view the illustrations, the FAQs, and read the testimonials.

If you are in the military, find out what other options your doc will offer you

At this point in my life I would probably have one or two stars if I had selected a military career and I would have anyone under my command court martialed if they did a cadaver graft on a guy under fourty, or any high demand athlete.

Thats my story and I'm sticking to it.

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Why any MXer would have an allograft is is question that I will never have an answer for.

I do, I do, call on me!!!

It's because there is lots of information out there--articles, on the web, word of mouth, all the usual ways--that says the cadaver graft IS stronger and heals faster. I've heard it from a few people. There is both misinformation AND an overabundance of info that is hard to sort through and the average person is stuck with whatever their doc tells them. I was lucky to have a good doc the second time and an OK one the first time.

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Firecracker, even proponents of allograft reconstruction don't say that those grafts are stronger. Be reasonable, they are dead, then frozen, then thawed. Can those things make a tissue stronger? I don't think so!

The reported advantage of the allograft is that the recipient knee doesn't have to suffer the ravages of a graft harvest inadition to an ACL Reconstruction. On that subject, I agree completely. Unfortunately, since the dead graft must be revascularized, then repopulated with live cells, it takes a year off sports. Even after a year, its never strong enough. Thats why there are articles in the Am. J. of Sports Medicine that advocate its use in non high risk athletes and sedentary people over 40. What the quintessential opposite of that? MX, I think.

Now what if a living isogenetic graft was used that did not come from the injured knee. The bone to bone healing would heal the bone plugs in one month,and all that would be necessary would be recovery from the surgery.

Thats what we do with the contralateral graft. It alive, its strong, it doesn't further compromise the all ready injured and compromised knee.

The downside is that while the athlete is working is ACL knee in rehab, he also has to do exercises for the graft leg which never hurts, but has to overcome some weakness over the first three months. As a practical matter thats not much work because when a regular guy goes to the gym, he works both legs rather than just one anyway.

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Well DrMark, I said I'd report back after I saw my surgeon so here goes.

First, my surgeon is pretty flexible about what type of procedure. In fact, he seemed impressed that I knew the difference between a hamstring and patella repair. He was a little concerned that he couldn't feel the knee pop out. He was trying this wierd flex that was supposed to make my knee pop out so he could confirm what the MRI said and that was that the ACL was completely torn off. But I was pretty stressed about him trying to "pop" it out so I tensed up and couldn't relax. In the end he couldn't get the answer he wanted.

So we agreed that we would book the surgery and he would repair the small miniscus (sp) tear and when I was under he would try to pop my knee and determine if the ACL is indeed torn. I don't know why he won't believe the MRI results.

Anyway, I discussed the patella option with him. He was of the oppinion that hamstring and patella both take 6 months to heal and are the same strength when you are done. I asked him about grafting from the opposite knee for the patella and he said he would do that if I wanted. But...

He said that patella grafts can weeken your leg by as much as 20% due to some kind of leverage the patella does from your quads to the lower leg. Specifically he said my quad strength would be only 80% after the graft. Does this sound right to you? I forgot to ask him about healing time with an opposite knee graft, but I'm concerned about having two weakened knees instead of one. Obviously I want the best of both worlds. I want the strongest ACL I can get as well as no apparent side effects in either leg later.

I was a little choked when I first heard about his 2 month holiday at the end of this year, but now I'm kinda glad. I want to research this as much as possible before I go ahead with it. Now the next question is about my CTI's. To wear, or not to wear. That is the question.

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Renes, is your doctor taking November and December off because he/she has all ready done his/her alloted operations for the year and the system will not pay him/her for any further work?

I have heard that that is the case in Canada and would like you to educate me on whether or not that often heard rumor is true.

Forty dollars per month, or 400 dollars per month? Both are a small price to pay for having a leg that works, no?

Thank you in advance for your reply.

I asked him about his time off. He said he simply works to hard and has accumulated alot of holiday time. He is going over seas to visit family. He said he has not heard of a "limit" for operations in a year. I also asked a co-worker who is married to a orthopedic surgeon (shoulders) and he has never heard of that either. But maybe Alberta is slightly different then other provinces.

I know Klien (our premier) wants to implement some privatization of health care. Most Albertans are not happy about it citing a two teared health care system for the wealthy and the poor. The Federal Govn't is pretty pissed about it too. The smoke has kinda cleared on the idea for now, but Klien is a pretty ballsy premier. He'll eventually get some privatization in here. The way I see it, having some privatization here should attract more doctors and thus the waiting times should decrease for everyone.

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Our experience is that between three and six months the quad strength on the harvested side is equal to what is used to be. No that doesn't come without a traing program on that side. Our athletes, all of who follow an appropriate training program for the graft leg, never have complaints about it.

By taking the graft from the opposite leg, the ACL leg has less to deal with and therefore its rehabilitation is signifigantly quickened.

I am in disagreement with you doc on several points. The hamstring graft is not good to go for riding until 9 months to one year. It takes that long because of the inherent difficulty in tendon to bone healing.

The patella tendon with its attached bone blocks on either end heal to their recepient bone in one month. Therefore, if the knee was well enough to compete, then it would be good to go at a month. By installing a patella tendon form the opposite leg, then that recepient knee will be good to go by three, rather than the six months your surgeon suggested for the patella graft which would be true if the graft came from the patella tendon of the same sided knee.

The strategy is to divide and conquer.

drmark

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I've had the hamstring graft,killed me not to ride or ski for a year,but did it, I'm 47 now had it 3 years ago,still ride the tracks,get big air, :banghead: so far no problems

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