ACL tissue POLL

So i'm part of the club now. Having surgery in 1 month
Wondering whos had ACL surgery and used your own tissue and whos had it done with donor tissue. Also, what are the pros and cons of each one?

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quote:

Also, what are the pros and cons of each one?

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You're having surgury in a month and your doc didnt go over this with you?!? Find a new doc!

-Steve

He showed me virtually what he planned to do which was use my own tissue but after talking with others who have had the surgery more than once they said that donor tissue is better. But yeah, he never mentioned donor tissue. I'll see him again in a few days and talk with him about it.

Here's some quick info for you:

Patellar Tendon Graft:
pro- This tendon is large and very strong, and so makes an excellent graft in most patients. A brace often is not even necessary following surgery, so the muscles around the knee have less risk of atrophying from disuse. This option is often used by athletes who wish to return to full performance as fast as possible.

con- The disadvantage is that the removal of the patellar tendon is more painful than the other options. Strong painkillers may be prescribed for several weeks following the surgery. The patellar tendon also takes about one year to fully recover; until then, there is an increased risk of tendonitis.

Hamstring Tendon Graft:
pro- The removal of hamstring tendons, however, is not as painful as the patellar tendon graft. Evidence suggests that the hamstring tendon graft does just as well, or nearly as well, as the patellar tendon graft in the long-term.

con- Unlike the patellar tendon, the hamstring tendons are not as strong. Therefore, following surgery, a brace is often used to immobilize the knee for one to two weeks while the most critical healing takes place. Because this procedure is less painful than the patellar tendon graft, this is often used when a faster recovery is unnecessary. Because the knee must be immobilized for the first week, there is often significant muscle loss, and a long course of physical therapy is necessary to regain strength.

Allograft (Cadaver):
pro- This method has the benefit that the most painful part of the surgery, the harvesting of tendon tissue, is avoided.

con- There is a slight chance of rejection which would lead to another surgery to remove the graft and replace it again. Even with the extensive and redundant screening process for donar grafts, there still runs the risk of infection which would be grounds to remove the graft. Therefore, this option runs the largest health risk.


-Steve

I had the patellar tendon graft done when I blew mine 4 years ago. Painful-yes! I was however back to work in 7 weeks and snowboarding full speed 5 months later. Good luck!

Allograft was the only option(Patella tendon graft) done 04/2005. Couldn't afford the down time and I was my own caregiver.
Pain was minimal & full range of motion with in 48hrs.
My down time 10 days before I went back to full duty with a knee brace... and I'm on my feet all day.
My advantage is having a Orthopod who is very anal on tissue he uses for transplantation and knowing the people involved with tissue retrieval.
My philosophy is - why would I want to sacrifice my own tissue with the possibility of failure or future joint replacement?
Follow the rules of rehab and you minimize your chances of graft failure.
Other issues:
- Age: if you're young and can afford the down time,use your own tissue. But just remember what I stated earlier. Also taking tissue away from one area, it adds to your pain and that area will never be 100% again.
-Complications: always a risk no matter what you do.
-Risk of disease transmission: I work in the medical field. Already been stuck with a needle from a full blown AIDS pt who died. That was over 11yrs ago.

Not everyone will agree and everyone heals/reacts differently.
This is from personal and professional experience.

Hopefully with the help of your surgeon,you will be able to decide what will be best for you.

I forgot to add I had mine repaired 10yrs after the intial injury.
I learned how to wakeboard without an ACL



(Message edited by phantom5815 on August 12, 2006)

Xgirl;

You will find a full spectrum of thoughts on what people think is better. Mostly because that is what they chose to have done. I myself went with the Pattelar graft for mine. I have found through lots of research that the Pattelar is concidered to be the gold mettal fix. I am not sure if that is 100% true but seems to be the overall concenses. I myself did not like the idea of harvested tissue (cadavar) being used and that was the biggest reason for me not choosing the allograft. I had surgery on January 19th and was back on my wakeboard on June 20 something.

when i tore my acl I did the petellar tendon graft...wasnt as painful as some people have said, took a while to heal(6 months recovery) but I havent had any problems with it since and its been 4 years

I just tore my acl about a month ago. Had a number of conversations with my doctor and ultimately decided to go with the patellar tendon cadaver graft. Being a friend of the family he was able to call the blood bank for me to give them my height and weight in order to get a more specific graft for the surgery. With all the impact my knees take, I just wanted to leave my patellar tendon in tact. Both grafts have great results though, good luck.

Theres alot of good info on all these posts and I am sincerely thankful to all of you for taking the time to give me so much insight on the the options that I have. Those of you that have the hook ups, the docs that are personal friends or friends of the family, are so very lucky. I wish I had that.
I hate that I actually have an option between donor or my own tissue. Im the most indecisive person I know so to have to make a decision is stressful.
I geuss i'm leaning towards them using my own patella since I kind of have till next season which is what? About 8 months till the weathers right and the comps start up again, to ride.
I just want whats better. I want the best. And i'd love to have the best doctor. One who knows wakeboarding. One who knows the massive impact we are taking.
I'm tempted to give this doc a wakeboard video so he can see what its all about.
My doc claims hes done at least 2 of these surgeries per week for the last 30 years and has never had anyone tear theres again. I find that extremely hard to believe and asked him if hes worked on many wakeboarders. He said no, mostly basketball players. I might be his first then is what I immediately thought to myself.
Please keep the info coming if you will. I really appreciate it.

I don't want put your Orthopod down, but I would just go ahead and get a 2nd opinion just so you can have some peace of mind.
Instead of asking your MD how many wakeboarders he's operated on, how about - how many people he's operated on that have gone back to playing their sport at the same level prior to their injury.
My surgeon definitely does more than 2 ACL's/wk. and he's been practicing for 15 yrs.
You might want to ask him when he has you starting passive range of motion and physical therapy.
This may give you some insight if he's up to date on the latest treatment/rehab. ( at least it would for me)

agree with statement steve mentioned.. it is a good idea to find out how the doctor was trianed and hos comfort level with the options...

here are some factors to consider...

-age
-recovery time
-pain tolerance

tissue donor (cadervic)- minimal risk of rejection compared to before... advantge is quick revovery * minimal pair - disadvantage is not as stong..btw, choice of usa ski team.

acl- pro..strongest of the bunch..con - painful & slow recovery (not good for older paitent)

hamstring -= good in paticular cases..strength will depend on condition of person (pro sports player will go this route for short recovery)

melanie,
as a physical therapist, i've seen all kinds of recons done (old ITB, hamstring-single and double looped, pat. tendon, allograft from pat. tendon and achilles.) i know of some surgeons who didn't place the graft well and that limited the person's ROM and caused all kinds of setbacks. i have seen people to equally well with pat. tendon and ham-some ham. grafts which were not taken off the insertion point would heal quicker (establish blood flow) and when double looped were as strong or stronger than the pat. tendon. the crucial questions for you aside from the actual graft is getting the guidelines/protocol from the ortho and knowing a good PT who will challenge you but not push so hard that you will get complications from rehabbing too quickly (yes, it can be done!) when it's time to resume all activities-including riding- you also have to be mentally confident- usually by going through a progression of rehab activities which will lead you to knowing you are ready.

i used a achilles tendon donor graft.. Much stronger than any other graft.. has 1 bone end for anchor and one tissue end. Used anchors that biodegrade so no metal left in knee.. Was at phys therapy 2 days later....and back at work as a Fireman full duty as a fireman 2 months later...
No issues so far done in dec 05- Go Allograft (Donor) no need to use your own tissue...

My surgeon told me that the type of graft also can depend on region, age (previously mentioned) and the specific surgeon's specialty. He mentioned that allografts are much more commonly used in southern states than northern. Not sure reasoning there. Surgeons typically steer older patients toward the allograft for recovery reasons, and while most surgeons can do allografts, they usually 'specialize' in either patellar or hamstring. Not to say they can't do both, but usually they're better or tend to prefer one over the other.

Sounds like you've pretty much got all the info you need to make a sound decision. Good luck on your upcoming surgery!!

Melanie,
I had the patellar tendon graft done in March.
I plan to take my first ride on my birthday, Aug. 25th. It was a very painful exp. but I am a super baby when it comes to pain. I ride my bike everyday for 1/2 hour, jog and weight train. You will be suprised by the amount of muscle loss to your thigh and calf. Work hard in rehab and you should do well. Good luck!
Sharon

The thought of all of the pain i'll have to go through makes me nauseous.