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ACL tear... here we go...

post #1 of 20
Thread Starter 

Did it playing soccer, a few days before a weekend of skiing... made a somewhat sudden stop, but nothing too crazy... felt a little pop and a some instability which seemed to go away.  I was stiff, but skied a couple days on the weekend without much trouble, felt a touch unstable, so called it quits early each day.  This sucks!

 

Though it was the meniscus, and so did my doc, but the MRI results came back today, and it's a full ACL tear.  So here we go... 

 

Doc prefers to do a patellar allograft(I think that's what he said - my head is still spinning), either mine or from a cadaver.  Not sure what to do here... currently researching, and going to talk to a few docs. 

 

Any thoughts or advice? 

post #2 of 20

I did a pateller graft on mine because I was told it was stronger and I didn't want to lose any function in my hamstrings.  If I was to do it again I would do a hamstring graft.  My doctor who recommended the pateller graft now does hamstring grafts.  My knee is strong, but the scar tissue around the patella is problematic.  It was hard to kneel on that knee for years.  I also think that the rehab goes better with the hamstring.  The real key to your full recovery will be with you and your physical therapist.  PT was pretty cool.  You might as well enjoy it.  My injury was more severe than just the ligament.  It didn't hurt that much.  A complete tear actually hurts more than a partial.  Good luck.

post #3 of 20

 

Quote:
Originally Posted by tetonpwdrjunkie View Post

A complete tear actually hurts more than a partial. 

? I thought it was the other way around.

post #4 of 20

That's a bummer.  I can tell you my hamstring reconstruction has been great for 12 years now, "knock on wood".  My wife just tore hers so I've been revisiting this a lot lately.  Here's what we have taken away from the last few weeks of appointments and opinions:

 

1) It doesn't seem like any docs really prefer the cadaver approach.  Still done as the the option when you're running our of your own tissues (tearing it again etc.), makes sense.  Cadaver tissue didn't sound good to me so I never considered it.

2) The patellar, good results historically, easier recovery, back to normal faster (work and day to day stuff).  Questions remain about patella structure/strength and kneeling pain etc.

3)  Hamstring, very popular now and it seems more docs are performing it more often or exclusively.  "Tighter" knee when finished?  More invasive to the leg (hamstring area obviously) and recovery can be a little longer.  It takes a long time anyway.

 

She's going with Hamstring as she wants the best result (in her opinion) surgically knowing that proper rehab will determine the longterm results.  The first week post-op is a write off as far as getting any of the ordinary day to day stuff done , you'll go to rehab etc., otherwise you just won't feel like it.  Plan on getting "really" started again after that, regardless of surgical approach, you'll be getting bored and the pain will really be on the way out. 

 

Do what makes sense to you though, mental confidence in and out of this process is important.  Don't hurry anything, especially on the backside, take it slow.  Use your time wisely do the rehab.  Push it hard but not too hard.  Around 3 months you'll be feeling really good and you will look to test it,  Be careful here and good luck.

post #5 of 20

Tomorrow is my 1 year anniversary for L knee hamstring autograft. I can not imagine being happier with my results.I skied 15 days this season. Mostly hike-to steeps, moguls. All day, each day. No problems at all. If it happens to my other knee, its hamstring only for me. Had perhaps my best season ever.

post #6 of 20

Mom your right....  I wrote it backwards.  A complete tear hurts less than a partial tear or a partial tear hurts more than a complete tear is what I meant to say. 

post #7 of 20

I didn't think that my dislocation that sheared all the ligaments, damaged both menicus and bruised the upper and lower bone platues was that serious at first because the pain wasn't that bad.  I still remember coming back from the doctors office on crutches trying to decide what to do, I had a bag of groceries under each arm and was giving the front door a little hip check to shut it and looked down and saw my knee move in a direction it really isn't supposed move.  It felt funny, but not that bad.  It was really disturbing to see though. 

post #8 of 20

 

Quote:
Originally Posted by MoreCowbell View Post

Doc prefers to do a patellar allograft(I think that's what he said - my head is still spinning), either mine or from a cadaver.  Not sure what to do here... currently researching, and going to talk to a few docs. 

 

Any thoughts or advice? 

Both patellar tendon and hamstring tendon autografts (autografts are tissues harvested from you and then re-implanted back into you) yield similar objective results, with neither one demonstrating superiority over the other in a variety of measurable clinical outcomes (such as laxity or muscle strength). Overall post=operative pain appears to be the same with either type of graft, though the former, not surprisingly, may be associated with more pain upon kneeling and a higher rate of anterior knee pain.

 

Go with an autograft, if you can. Observational studies have found a higher failure rate with ACL reconstructions that utilize allografts (allografts are tissues harvested from someone else, and in the case of ACL reconstruction, a dead someone else, or cadaver) compared to autografts, leading a recent reviewer to conclude that "the avoidance of allografting is prudent when possible in young athletes."

 

Wishing you a speedy recovery,

 

Rick

post #9 of 20

I went with a "double bundle" allograph (= two grafts which is more similar to your original ACL but from a cadaver) almost 5 months ago.  Feels pretty good overall, but still a bit of swelling.  Have been skiing for a month (very gentle first 3 times for 1-2 hours, pushed it more the last 3 half days). 

 

Wasn't aware of it beforehand, but can't dispute what others have said about studies showing your own tissue may make for a stronger graft, but did like the idea of using two grafts to more closely replicate the original ACL.

   

It amazes me how different each doctor's protocol is.  If I had to do it again, I might look into a hamstring graft, but it does have the drawback of weakening this muscle a bit.  I also found some recent posts by Jamminski and his link to his Doc's protocol very interesting (early focus only on range of motion with little or no strengthening exercises the first 3 months to avoid stretching the graft). http://www.epicski.com/forum/thread/79848/acl-reconstruction-patellar-or-hamstring-graft

 

Everyone seems to agree that getting range of motion is important, (and I witnessed another guy at PT who had problems because he didn't push this enough early on) but there is definitely differences of opinion in terms of how long to wait for different exercises/activities. 

 

The more you build up your muscles, the more support you give your knee, but pushing it too much may strain the graft which is not a good thing.  In my case, my PT thought the graft was tighter than than my other knee at 6 weeks, about the same at 8 or 10 and about 10% looser at 12 weeks.  Doc thought it felt fine at 12 weeks and the PT thought the extra 10% looseness was no big deal.  I felt comfortable with them overall and they may be 100% correct, but there is a part of me that thinks maybe I should have waited a bit longer before starting some of the PT exercises that I was doing weeks 6-12.  I probably should have waited a bit longer to start shoveling snow also...  

post #10 of 20
Thread Starter 

Hey guys,

 

Thanks for the kind words.  I've decided to go with the patellar autograft - I was lucky to not do additional damage to my knee, and by all measures, it seems I should have a good result.  After doing a lot of research on the double bundle vs. patellar autograft, seems as long as my surgeon is good, and I rock the post-op physical therapy, I'll be in great shape.  For now, just spending the next 2-3 weeks getting my leg as strong as possible before I go under the knife.  My surgeon also did my left meniscus this fall, so he knows me, and what I want to achieve, and I have a lot of confidence in him, so fingers crossed.

 

The one thing I'm really not looking forward to is being on crutches in NYC...  Ugh.  

 

All that aside, my surgeon seems to think I will be able to jog only 2 months after surgery - perhaps I heard him wrong, but does this seem possible?   

post #11 of 20

I am in the same boat as you.  My MRI showed a near complete to complete tear of the ACL.  I was skiing on icy, choppy snow and hit a pile that caused my leg to twist all the way around.  (I'm going to have my skis tuned soon and am curious if there was a problem with my bindings)  I didn't hear the pop, but it happened so fast and groomed snow is not quiet.  I thought I was fine, until I tried to stand and my knee felt like it was sliding off to the side!  I am getting ready to have a Pateller autograft in the next couple of weeks.  I feel like this is the best option as my doctor, who takes care of U of TN athletes, said this is the best way to go for a strong and lasting result.  I have been trying to keep a positive attitude and plan to work hard at PT and do exactly what they tell me to!  As far as being able to jog in two months, my doctor told me after three months and I can jog and bike.  It may be my age (46), if you are younger you may recover quicker.  I skiied about 23 days this year and for living in the SE, I was pretty happy.  I hope your surgery and recovery goes well.  Keep us updated, and I will do the same.  We need to share our experiences with the next person in this situation.  If anyone has had this surgery and can share results and encouragement, I would be grateful.

 

I'm planning on keeping up with my 19 yr old come December (At least close behind )

post #12 of 20

I never asked my Doc about it, but I don't think I would have jogged at 2 months even if I liked it...my PT said to wait until at least 5 months before I did full out running (in part because I still had/have some swelling)...My Doc did say I could snowshoe and x-country ski at 12 weeks (neither of which I did) but I started to gradually get back into skiing at 4 months.  I am skiing conservatively for me and limiting myself to once a week, but the knee has felt pretty solid the last few times out (I am now almost 5 months post-op), but I am still having some swelling.  The most encouraging thing is that I feel like I should be able to ski at a high level next season. 

 

I have been riding the stationary bike since the beginning of PT, but never asked when it would be ok to road or mountain bike.  I was given the ok to swim crawl (and later side-stroke) pretty quickly (maybe 12 weeks or sooner), but was told to wait until 5+ months for breast stroke.

 

Each Doc has their own protocol and they have more experience than I do, but my recommendation would be to keep on top of the PT exercises that help to get your range of motion back as well as the strengthening exercises that don't put a strain on the new graft.  However avoid any activities that might strain the knee or graft for at least the first 3 months and don't feel that you have to be ahead of schedule or push to do PT strengthening exercises that put a lot of strain on the knee. 

 

Eventually, you want better muscle support for the knee than before the injury, but this has to be balanced against the risk of stretching the graft early on and giving the knee a chance to heal from the trauma of surgery. 

 

Good luck... 

post #13 of 20

Best wishes for your surgery and recovery. I got a hamstring + adductor autograft a little less than a year ago, and could not be more pleased with the results.

 

 

post #14 of 20

Hope you have a good rehab! I am 13.5 months after an ACL allograft using Achilles tendon tissue, and just had my 60th ski day this season. Mine is working fine as I'm sure yours will!

post #15 of 20
I'm 8 weeks post-op. I had a full left ACL tear and small meniscus tear in April. They couldn't get me in for surgery until June 2, I opted for the cadaver graft as my surgeon was far more comfortable with those and it seems like there are ups and downs to either allografts or autografts.

They let me swim after 2 weeks - once the incisions were better, but they didn't say anything about avoiding the breast stroke or anything. I've also been riding my bike a lot, they had me on the stationary bike on week 3 and gave me the go ahead to ride my own bike a few weeks later. They just said to avoid pedaling really hard uphill.

I'm hoping to be able to ski next winter, but we'll see how it goes.
post #16 of 20
Hi all,

I am in the process of joining the party !

Well, not yet though.

I have a complete tear of the ACL and partial tear of the meniscus.

The thing is that I feel my knee is very very strong.  The only pain I have is when I bent it backward beyond a certain point then the pain is huge, however the dr said that is due only to the meniscus.

So, of my million questions, here is just one:  why wouldn't I first take care of the mensicus, then see how it goes and decided whether or not I should also go for ACL reconstruction ?

Also, anyone in NYC ?  please touch base !

best to all !
post #17 of 20
Welcome to Epic.

Taking care of the meniscus only is an option.  I tore my ACL and partially tore mcl & meniscus and went for the ACL replacement (along with meniscus trim) in November '08 and am happy with my decision.  I chose this approach as I wanted my knee to be as strong as possible for skiing & basketball and didn't want to take a chance of further injury on a less than 100% stable knee.  Others have successfully skied without an ACL so if your knee feels strong, maybe this would work for you...what does your doctor say? 
post #18 of 20
Quote:
Originally Posted by tetonpwdrjunkie View Post

Mom your right....  I wrote it backwards.  A complete tear hurts less than a partial tear or a partial tear hurts more than a complete tear is what I meant to say. 


I never had a partial ACL tear to make a clear comparison but my complete ACL tear during a tail landing hurt a real lot, but for a real short time duration - like for 1 second while it was tearing, and then no pain. The pain while it was tearing was intense enough that I knew my knee was hurt real bad, and I went completely down in a lump.

I'm 17 months out of surgery and it feels normal now.

I frequently ski with one very fine skier (PSIA III) that skis without an ACL in one knee and wears a brace on that knee, and you would never know it when you see him ski. I considered this option myself, but was warned by several health care professionals about a much greater risk of early osteoarthritis and I decided to spend the $20K on the surgery and protect my knee for the future (I had no other knee damage, just a totally ruptured ACL).

BTW, I plan to use Kneebindings again this season for any re-injury mitigation they offer - short money in the overall scheme. I skied on them for the last 47 days of the 61 days I skied last season. The first 14 days I skied last season were before they arrived and got mounted, but during that initial period I skied in super-soft re-hab boots (Lange 80 RRS) which was wierd but probably reduced the stress on my 8 month old graft. Once I had the Kneebindings I returned to medium stiffness boots (Nordica Speedmachine 110), but I never returned to my stiff boots (Lange WC140). In retrospect, I think starting off in soft re-hab boots was a good plan. The wierdness of the soft imprecise feel was far less wierd than what was going on in my head those first few days back on skis...
post #19 of 20
Quote:
Originally Posted by MEfree30 View Post

Welcome to Epic.

Taking care of the meniscus only is an option.  I tore my ACL and partially tore mcl & meniscus and went for the ACL replacement (along with meniscus trim) in November '08 and am happy with my decision.  I chose this approach as I wanted my knee to be as strong as possible for skiing & basketball and didn't want to take a chance of further injury on a less than 100% stable knee.  Others have successfully skied without an ACL so if your knee feels strong, maybe this would work for you...what does your doctor say? 

Thank you MEfree30

Sorry I could not respond earlier for various reasons...

To respond to your question, one dr. was adamant about doing both together, another was much more open to the idea of doing one first, see how it goes and then decide.  Sure enough I went with the latter and had my meniscus repaired last Thursday.

The surgery gave the dr the opportunity to actually confirm visually the complete tear of the ACL.  He did express some concern that the repair might fail due to the missing ACL.  Oh well, that was and remains the game plan.

Again, my knee felt totally strong, 100% with the exception of the pain when bending all the way back, which was due the the meniscus.  Now we shall see as I recover how thing are.
post #20 of 20
good luck...seems to me that keeping the supporting muscles strong will be one of the keys to your success...
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