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-   -   ACL graft, which type and why... (http://www.wakeworld.com/forum/showthread.php?t=721446)

dyost 07-30-2009 8:28 PM

Did my ACL July 2nd, now have to decide how I want to get fixed and schedule my surgery. My options are patella tendon autograft, or allograft from a cadaver. Anyone who's done an ACL, I'm just wondering which route you and your doc went and why? What were the pros/cons your doc told you about each method? <BR> <BR>The doc I'm seeing is suggesting patella tendon, citing it as the strongest anchoring for the new ACL (due to the bone on bone healing from the graft they harvest). Also saying it will be the tightest/strongest once healed. <BR> <BR>They don't see a lot of wakeboarders here in central Illinios (I'm trying to educate him on the sport and the physical demands, impact from landings, etc). Is there anything specific about either way that makes it a better or worse choice for wakeboarders vs. other athletes? <BR> <BR>And those from the other ACL thread, please don't suggest I get a brace and ride on it or re-tell stories how you've done so. Looking for info as my 2nd consultation is in a week. <BR> <BR>Thanks

dyost 07-30-2009 8:31 PM

Also, anyone from the Central Illinois area, if you have any experiences with Midwest Orthapedic Center let me know which doc you saw and what you thought. I haven't been in this area too long, but this group came very highly recommended.

toadieboy13 07-30-2009 9:37 PM

I had ACL reconstruction with the patella graft about 27 months ago. I went with this option after doing alot of research and because my ortho recommended it for my case. He cited the exact same things as your doctor. He also said it really depends on what sort of lifestyle you plan on leading after the surgery. He recommended the patella for young people who are going to remain active. <BR> <BR>I did a ton of research when trying to decide which graft to use. If you look hard enough, you will find plenty of good things and plenty of bad things about each option. One interesting web site I found stated that 31 of the 32 NFL teams have their players get the patella graft. (Not sure if it's true or not). <BR> <BR>I think alot of the times the orto will suggest the procedure they are most comfortable with. <BR> <BR>I had a friend who had ACL reconstruction the same time as I did. She had the cadaver hamstring graft. She seemed to recover quicker than me and did not have near the pain and swelling I did. This make sense since they did not harvest part of her kneecap and tendon for the graft. So, from my experience and research, I think the patella is a little more painfull and a little slower recovery than the other options out there. My ortho told me it would be about 18 months before my knee would be close to 100% and he was right. It seems to keep getting stronger and feeling better all the time. <BR> <BR>Another thing with the patella graft is they have to cut a nerve in the patella tendon to harvest it. This leads to a large (4" x 3") section around your knee that is permanently numb. <BR> <BR>If I had to do it over again, I would still do the patella graft. <BR> <BR>Good Luck.

hudd007 07-31-2009 12:03 AM

Sorry about your injury Dustin but please don't risk your health based on what people here say (no offense people here) but listen to your doctor. If you want a 2nd and 3rd opinion see other doctors. Chad had some great insight but I consider him the exception to the rule.

alans 07-31-2009 4:43 AM

I have done both the Hamstring and Cadaver. I liked my hamstring graft better until I blew it 5 years later. Cadaver is much "looser."

dyost 07-31-2009 5:22 AM

Sean, totally agree, I'm not taking this advice as gold. Like Chad, right now I'm just doing some research on different methods, etc so I have some intelligent questions to ask the doctor. <BR> <BR>Things like Chad's statement about permanently numb knee, or aching knees later on from patella graft, etc. Ultimately doc's recommendation reins supreme over opinions of Wakeworlders. However, if I'm not comfortable with his responses or suggestions I may have reason to seek out a second opinoin.

jmuthafnp 07-31-2009 5:25 AM

I am in Southern IL and I have had the hamstring graft, which they have harvested from my own body. Not a fan of the patella graft, my riding partner had it done, blew it out again within two years. Remember everyone's body is different. Just my .02. I can recommend an awesome Dr. in the St. Louis area, hit me up if you're interested.

alans 07-31-2009 5:45 AM

You get the numb knee thing regardless. 4 out of 5 of my riding crew has had ACL reconstruction. We all have the numb thing. <BR> <BR>(Message edited by alans on July 31, 2009)

xbones 07-31-2009 6:16 AM

As I commented before on the other thread... Alex and I both had the cadaver hamstring and have had great success. This is Alex one year post op: <BR> <BR><a href="http://vimeo.com/5846307" target="_blank">http://vimeo.com/5846307</a> <BR> <BR>My other buddy Mike Pearson had a patella graft and the first week back on the water, his knee cap split into. <BR> <BR>I'm not going to tell you which one to get, thats for you and your dr. to decide, just giving my experience.

gene3x 07-31-2009 6:30 AM

My Doc told me that cadaver is definately a quicker recovery but will likely be less robust as using your own tissue mainly because the graft is coming from an older person. he said, and I have read in journals also, that the hamstring will be more plyable and stretch a little before it breaks. The patella and hamstring tendens are typically about the same strength but as you cited, the patella has a better attachment method due to the bone plug. I have read as well as heard first hand that it also has more pain and recovery time though. <BR> <BR>I went with hamstring and call tell you that it is definately not pain free. goodluck with your choice.

dillls 07-31-2009 6:36 AM

Here are my first hand experiences with ACL tears. Keep in mind these are my opinions and in no way am I telling you what to do or whatís wrong or whatís right. <BR> <BR>Blew my left knee out riding on 6/18/08 and got hamstring graft done on 7/28/08. I did the same as you- talked to riders here on WW and did endless amounts of Google searching on what was the best option to go with. You will find everyone has different opinions on this matter Doctors and patients. In the end I went with the doc I felt most comfortable with and he did the hamstring autograft. <BR> <BR>My surgery went great, and my swelling went down quickly and got full motion in my knee within 2 months. One thing I did underestimate with this procedure was the pain from harvesting of the graft. As of today, my hamstring is still not completely recovered. I did a ton of rehab after this surgery, hitting the gym up 6 days a week. By 6 months I was squatting more than I ever had, thus my knee felt great and very strong. <BR> <BR>At 7.5 months out (mid Feb 09) of this surgery I tore the repaired knee again while lightly messing around playing basketball. I was wearing my custom fitted CTI pro sport brace. <BR> <BR>Due to work and my first child on the way I had to put the second surgery off a little. I think this will end up helping me b/c I have still been rehabbing it a lot so my knee is now much stronger going into the 2nd surgery than the 1st. I am actually going to get it done next week on 8/5/09. The doc who did my first surgery wanted to do a patella from my own knee for the second. Two close friends of mine got this procedure done and both are having a lot of pain from the graft and one tore it already. Knowing my hamstring is still jacked up; I did not want to be dealing with pain on in my knee from another graft. This led me to looking at donor grafts. <BR> <BR>I am going with an Achilles tendon donor graft. The doc I am going with is the only doc in my area (Harrisburg, Pa) who does this procedure. He claims that it is the strongest tendon in the body and each graft he gets is very large. As compared to harvesting your own ligament you donít really know what you have to work with until you get it out. My previous research before my first surgery I found much saying that a donor graft will not be as strong as a hamstring or patella graft of your own. However, my hamstring graft seemed to tear easy. So who really knows what is better. All I know is that I looking forward to getting a surgery that will hopefully be less painful and have a ligament that will not tear on me again. <BR> <BR>You will be fine with whatever ligament you go with. Just listen to what your doc tells you and rehab the knee like itís your job. Also, take your time getting back into the sports you do. <BR> <BR>Good luck!

parkgirl 07-31-2009 7:46 AM

I agree with Josh. I was in your exact position 7 months ago and like you, I asked WWer's so I had a whole bunch of educated questions to discuss with my Dr. We discussed all three methods in length, and what he basically said is "if there was ONE best way to go about it all Dr.'s would use that method" but there's not, so there is a lot of room for interpretation and decision based on the patient's needs and the Dr.s training. He specializes in the allograph cadaver reconstruction and has not ever had one fail, be rejected or infected. His confidence in this method and his reasons not to do the other's led me to go with that option and I could not be more pleased with my results. <BR> <BR>I could not FATHOM the idea of weakening one part of my knee permanently to fix my ACL (a.k.a the Patellar tendon method.) It seems to be the most popular choice though, so I asked him about and his thoughts were that it is the tried and true method that has been around forever. Many Dr.'s were trained with that method so they just stick with it, instead of moving forward to more advanced techniques. <BR> <BR>He also explained like Josh stated that he's opened up huge football player's legs to use their hamstring and come up with a tiny noodle, which he then has no choice but to use. You never know what you'll get when you use the hamstring. <BR> <BR>Honestly, the surgery is the easy part. What I believe determines the ultimate success is how much effort you put into rehabbing it, no matter which method you use. <BR> <BR>Good Luck to you I hope all goes well, and sorry to hear about your knee!

liquidmx 07-31-2009 8:06 AM

Well put Andrea, my sentiments exactly!

detonate69 07-31-2009 8:40 AM

I had patellar done about 5 years ago. was back riding at 100% in 6 months. Had some numbness around the knee cap. It slowly went away where now it's completely gone. It all depends on your doctor. My doctor recommended the pattelar because in her opinion it is the strongest way to go, and she is a sports specific ortho. I was off crutches in 2 weeks and was back wakeboarding in 6 months. I haven't had 1 regret about the way I went. Re-Hab is the ultimate test of how well you'll recover. Re-hab hard and you should recover well, take it easy and it'll be a long hard road. <BR> <BR> In the end do some research and talk to your doctor in length. He's the one that's gonna be cutting you up!

ronixrider456 08-01-2009 10:10 PM

hamstring graft for sure!

aroed 08-03-2009 3:25 PM

just a couple days over 6 months out of hamstring graft, going pretty good and waiting for my brace to come in so i can ride. i would recommend hamstring. although i hear good and bad things about patellar and hamstring. the allograft or cadaver is used mostly on female and professional athletes because females are more likely to tear theirs and some times their hamstrings are not good enough to graft them. Pro's also get allografts because they come back earlier and have a higher chance in tearing again so why make the rest of your leg weaker. so allograft maybe be the way you would like to go if you wakeboard alot and are pretty progressive with your riding. <BR> <BR>(Message edited by aroed on August 03, 2009)

masonmeuth 08-03-2009 4:16 PM

I had a hamstring graft and was back diong inverts maybe 5 months after surgery. Previously I had an incomplete tear in the same knee that they just "tightened" It tore completely 2 years later. It is my opinion that the Hamstring grapht is prolly the most painful and to be honest my hamstring hurt really bad a few tiems i pulled it a few months after surgery but once it heals its unbeleivably strong... To be honest tho the main thing is to <b> i did my second time around and it made the biggest difference.</b>

masonmeuth 08-03-2009 4:21 PM

Oops I meant to say at the end make sure u find the best doctor that u possibly can that really takes pride in his work! Some docs just slap everything back together.... But yea the hamstring grapht was the most painful thing i have ever experienced in my life. I had 3 pins and a "button" placed in my knee also to attach the ligament to the bone.... My surgery was done in germany tho so i dunno how urs would be different.... I know german doctors suggest hamstring tho! They gave me a choice between the patella donor and hamstring and I asked which would be the strongest and the said ham string hands down. Also I remember him saing something like the hamstring has the ability to heal itself unlike the acl and that the ligament itself is one of the strongest in the body. hope it helps

newchicago 08-05-2009 4:27 PM

There is a pretty detailed thread from back in January when I tore mine (around the same time Andrea did, I believe). Much was debated. <BR> <BR>For the record, I went hammy and couldn't be happier. The only one that I've had people tell me they regretted was the patella because they had pain even many years later (mainly when kneeling). <BR> <BR>Good luck!

newchicago 08-05-2009 4:39 PM

The thread is titled "ACL Questionnaire" (I'd provide the link if I knew how). <BR> <BR>Also something more to debate... my Doc didn't want me to use a brace at all. he thought it was all in your head. I never used any kind of brace (or constant motion machine) and have never regretted that decision. I'm at 6 months and feel great. I've been out riding a few times with no problems. I don't hit the double ups like most of you, but the riding has been fine. <BR> <BR>Again, best of luck. It sucks for sure, but you should be good to go for next season.

parkgirl 08-05-2009 5:20 PM

<a href="http://www.wakeworld.com/MB/Discus/messages/65919/655683.html?1234980637" target="_blank">http://www.wakeworld.com/MB/Discus/messages/65919/655683.html?1234980637</a> <BR> <BR> <BR>very helpful thread!

dyost 08-05-2009 8:36 PM

2nd consultation was today. We've got it narrowed down to patellar tendon autograft or achilles tendon allograft. He's telling me that the patellar tendon will the be the strongest overall. My only concern is cutting up the good tendons on my kneecap, although he says the patella tendon will heal back to it's original size and shape over time. <BR> <BR>This sucks, just when I start thinking I've made a decision I start thinking I'd like to go the other way.... <BR> <BR>Need to figure it out soon as my surgery is tentatively schedule for three weeks from tomorrow. <BR> <BR>Thanks for all the advice and input.

dyost 08-05-2009 9:24 PM

My 2 biggest concerns <BR> <BR>1. Weakening my leg from the patella tendon graft. If I was 100% certain the tendon and kneecap would heal back to their original size and strength, this would be a no brainer. My doc tell me it will, but I've heard enough other experiences to question this. I am convinced this is the strongest graft (due to bone plugs), but don't want to weaken another part of the knee. <BR> <BR>2. Re-injuring an allograft. Risk of infection/rejection doesn't bother me. I just don't want it to loosen or rupture again. Actually, if I had an allograft and ruptured it again, I'd just fix it with another allograft. But another busted ACL means potential for mensicus damage and that's what really worries me longer term.

dillls 08-06-2009 10:06 AM

Just had my ACL repair done yesterday morning. I did go with achilles tendon allograft. I feel hands down way better than after my 1st surgery, which was an hamstring autograft. For that surgery on a pain scale of 1-10 (10 being the highest amount of pain) I would say it was around an 8-9. This surgery I am barely at 2-3. I did get a nerve block for both of surgeries, and I would highly recommend one for you. <BR> <BR>The doc showed me the graft before I went under and it was huge. Andrea made some excellant points about using your own ligaments earlier in this thread. <BR> <BR>Obviously if I could do it over again I would have just got the allograft to begin with, but that is easy for me to say now after I have already torn my autograft. I would think that most people will not end up tearing their ACL twice like I did. So maybe the patella might be your best bet, since they can use the bone plugs. However, I can tell you that my hamstring to this day still does not feel 100%. From hearing what people say about the long term effects from the pettala surgery and knowing a guy who has torn his, it would make it tough call. <BR> <BR>If the patella was guaranteed not ever rupture again then to me it would be a no brainer. But, with the long term pain and the outside chance of tearing it again I would go with a allograft. <BR> <BR>I am taking some vicodin so please excuse any mis spelling or bad grammar. <BR> <BR>Good luck with whatever procedure you decide to go with.

dyost 08-06-2009 8:28 PM

Does anyone know what some of the pro riders are getting when they do an ACL? Not that I'm anywhere near that level of riding but, it would be interesting to see what they're having done. <BR> <BR>I'm sure they see very good doctors who are very familiar with wakeboarding and it's toll on the legs/knees. Just wondering if one method is preferred over another for this specific type of sport. <BR> <BR>Thanks again for all the advice everyone. Three weeks from today I'm tentatively scheduled for patella autograft. If I decide to change my mind for the achilles allograft I need to do it ASAP so they can request and secure the cadaver graft. That or I can reschedule....

dizzyj 08-06-2009 9:11 PM

where are the carbon fiber and polymer options? How about some stem cell grown tendons? medicine is a sham! <BR> <BR>I'd probably go with the cadaver, that way I wouldnt care as much if I tore it again. Plan for the future, thats what I say!

tahoepete 08-07-2009 9:50 PM

Just make sure your doctor has done a TON of replacements. Mine had done a lot of hams and patellars and was of the opinion the patellars stayed tighter and stronger longer, and allografts were a little more unpredictable. The recovery for patellars is definitely longer and more painful than the allograft, a lot of pros go that route for a quicker rehab. I had patellar and have had excellent results. Just make sure you are patient and let it heal so you don't re-tear it regardless of what type.

ukiman 08-07-2009 10:52 PM

my buddy was on the tour briefly a few years ago and blew his ACL riding. Did the patella graft and then blew the same one riding a few months later on a double up behind my boat. Did the cadaver graft the second time and quit riding for the most part. still wakesurfs alot, but after two ACL's wakeboarding decided to hang it up. Bummer too, he was ripping

triskelstar 08-11-2009 5:33 PM

Tore my first ACL May 2009 riding my dirtbike, then tore my left ACL in August wakeboarding. Repaired both this winter with allograft. Waited 7 months (heavy rehab) after my 2nd surgery before wakeboarding. Tore my Left ACL for the SECOND time wakeboarding after about 2 months of wakeboarding on my repaired ACL. <BR> <BR>Going to do an allograft again. I'll let you know how it goes. I'll only be wakesurfing from now on unfortunately. Surgery date is August 26, 2009.

mc_x15 08-11-2009 5:42 PM

I had the patella graft. I personally have not had one problem since. Also used Dr. Russel Warren who does all the Giants and Jets knee surgeries. If you can get a specialist do it. From what i've heard and experienced its very worth it. May cost a more but its your knee. Thats how i looked at it at least. I had mine done about 5 yrs know. I snowboard, skateboard, wakeboard, hike, pretty much whatever i want and have no pain at all. Tough right after the surgery, but after about 2 wks you'll be feelin better.

ryjam 08-13-2009 2:08 PM

Hey Dustin it is pretty simple. Looks like you have gotten a lot of good responses, but it comes down to two things. <BR>1. What the doctor is comfortable with is probably the number one factor, you dont want hime to do patella if he is used to hamstring. <BR>and <BR>2. Recovery time. I personally looked long and hard and talked personally with mulitple doctors and people who had it done. Hamstring graft was the best option. I knew two people who went patellar tendon and two who went hamstring. Everyone turns out fine pretty much. <BR>HOWEVER, gone to Physical threapy for 6 months and I can assure you that an allograft is the best method. Why make your knee weaker by removing more parts. Before surgery I could squat 400+ pounds, now I am lucky to get 315 and that is really pushing it. My leg strength and balence is horrible in comparision to what it was. With this said it has only been 8 months since surgery. <BR>But in comparison to allograft paitents, they seem to have much faster recoveries and better success. Long run...about the same, but it sure is a lot of pain and hard work. <BR>This would be my rating scale <BR>1. Allograft <BR>2. Hamstring <BR>3. Patellar <BR> <BR>The main thing to remember is going to PT is the best advantage you can give yourself, I was able to wakeboard (at a very low and controlled level) at 3 months out. Which, i do not suggest, but I couldnt stop myself lol. <BR> <BR>Good Luck <BR>Keep in mind I was no stranger to exercies (Personal Trainer before accident)

dyost 08-18-2009 11:14 PM

Thanks to everyone for the great info and stories. In the end I made the decision to have the patellar tendon graft. I saw two doctors and they both recommended this method due to strength of the graft. I know rehab will be a bit tougher early on, but am willing to fight through knowing I'll have a very solid knee. <BR> <BR>I was so close to going achilles allograft, but just wasn't sure I'd have as predictable results. What really sealed it for me was when I told my doc that my only concern with the patella graft was knee pain longer down the road (in 20 years when in my 50's). He pretty much said that as much wakeboarding and basketball as I'm doing I'd be bound to have sore knees later on anyways, regardless of operation. Made sense to me I guess. <BR> <BR>He told me that assuming 100% perfect operation and 100% perfect graft incorporation would yield exactly the same result in knee stability with either patella or allograft. I just felt my odds might be a bit better with my own tissue, plus the graft will incorporate faster which should mean faster to 100% riding. If patella is good enough for Tom Brady than it's good enough for me... <BR> <BR>My surgery is next Thurs, Aug 27th. I'm not gonna check this post at all till the day after cause I'm afraid I'll second guess my decision (which was very hard to make!) <BR> <BR>Thanks again for all your help. I think it would be very interesting to compile a survey from wake worlders for future ACL reference. Questions like how old were you at time of surgery, male/female, what graft you had, results (post op knee stability/laxity tests vs. pre-op), wakeboard skill level, etc. This could be a huge help to the next poor soul that busts his or her ACL.

08-19-2009 10:50 AM

Well Dustin we can compare results haha. I'm going under the knife tomorrow for a hamstring. Went down this past saturday riding, got an MRI and saw the doc today, torn ACL, MCL, partial LCL, and meniscus, plus i have random cartilage floating around and damage to the posterior lateral corner. Gonna be a fun one. First time, we'll see how it goes. Good luck next Thursday!

toadieboy13 08-19-2009 9:10 PM

Good luck and speedy recoveries to both of you!

brodie_chaboya 08-19-2009 10:12 PM

I would recomend the allograft which is what I got. I have seen at least a few guys use their own tendons and then re-tear those ones within the next year or two. I think most Athletes would want cadaver/allograft so when if it happens again you didn't just waste some of your own body parts right.


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