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Old     (ERaced)      Join Date: Jun 2014       10-14-2014, 11:40 AM Reply   
I landed a raley a bit awkwardly a couple weeks ago and now i'm stuck with a torn ACL. Now I'm posed with the decision of which surgery to get. I'm between the Hamstring or a Patella graft. Just wanted to here from people who have gone through this before and see what ya'll have had and what the pros and cons of each are. I have done a bit a research on medical sites about the two, but trying to decide which graft would be best for me, considering I spend most of my days strapped to a board (Wake, Kite, Snow).

I know i'm not the only one on here that has torn an ACL and I know there have been several threads about this in the past, but people never really got into which type graft they got.

Thanks
Old     (tonyv420)      Join Date: Jul 2007       10-14-2014, 12:02 PM Reply   
hamstring graft on my left knee, and a cadaver on the right
Old     (skiboarder)      Join Date: Oct 2006       10-14-2014, 12:16 PM Reply   
I had a hamstring 13 years ago with no issues ever. My advice is don't worry so much about the procedure as the doctor. Find a great doc and go with what he is best at.
Old     (riddick)      Join Date: Jan 2010       10-14-2014, 3:50 PM Reply   
I could be wrong, but i believe you can get into the weight room quicker with a hamstring graft which will get you back into physical activity sooner.

Your surgeon should be the best source of knowledge on this topic. From my experience, be sure to go with a surgeon that has experience with athletes. There are a lot of orthopedic clinics out there, so choose one with a doctor that specializes in treating your local college or pro teams.
Old     (jww)      Join Date: Oct 2013       10-14-2014, 4:55 PM Reply   
did hamstring 2 yrs ago, ... if i had to do it again, i'd go cadaver.... my 2 cents...
Old     (brhanley)      Join Date: Jun 2001       10-14-2014, 7:26 PM Reply   
I did patella about 9 years ago because that's what my doctor did 90% of the time (might have been old school). Can't complain with the results, though. Took a bit longer to reach milestones, but was riding by 6 months and riding hard by 1 year without brace. Rehab is going to be key no matter what. Hit that up hard and you'll be back and potentially better than ever.
Old     (doubleup16)      Join Date: Sep 2007       10-14-2014, 10:48 PM Reply   
Had a hamstring graft in 2008. I went that route because I need to kneel down alot for work (construction) and was told it could be very painful. I still ride with a brace, but it is mostly mental.
Old     (ERaced)      Join Date: Jun 2014       10-15-2014, 11:11 AM Reply   
Thanks for the input. The doc i'm working with is recommending the patella graft, but all my buddies that have had acl surgery have had the hamstring. The surgeon i'm with does work with the Houston Texans.

@ jww: why would you say go cadaver over hamstring? Isn't there an increased risk of failure going with cadaver?

@ tonyv420: Since you have had both hamstring and cadaver, which did you prefer?
Old     (tonyv420)      Join Date: Jul 2007       10-15-2014, 11:20 AM Reply   
much faster recovery with my cadaver implant
Old     (99Bison)      Join Date: Sep 2012       10-15-2014, 12:45 PM Reply   
Patella about 20 years ago here. As others have said, it's all in the rehab and how your body recovers from the hamstring or patella injury as well. The patella makes you take it easy up front IMO, which is a pretty good thing
Old     (Orange)      Join Date: Jun 2012       10-15-2014, 1:07 PM Reply   
Quote:
Originally Posted by ERaced View Post
The doc i'm working with is recommending the patella graft, but all my buddies that have had acl surgery have had the hamstring.
Ask your surgeon why he recommends the patella versus hamstring and the pros/cons of each technique in your case. It's never a bad idea to find a second surgeon to confirm the advice if you don't have the utmost trust in your surgeon.

As for your buddies? Unless they also are orthopedic surgeons, don't take their medical advice and leave the technical stuff to the pros. Friends and other patients that have had similar injuries are awesome resources for what to expect in rehab and recovery, but they don't know squat about medical techniques and risks or how they apply to your case. Techniques change over time, not ACL injuries are the same, and not all patients are the same.

Chances are high your surgeon is giving you the right recommendation and its just a matter of you getting comfortable with why that technique is best in your case. If you don't have a high trust level in your surgeon, go get a new surgeon or at least get a second opinion.
Old     (riddick)      Join Date: Jan 2010       10-15-2014, 6:58 PM Reply   
I would go with what your doc says if he works with the Texans. I would be sure to explain the in and outs of wakeboarding to the doc to see if he understands what you plan to do once you recover 6 months later.

Also, I disagree with the cadaver resulting in a quicker recovery. Reason being is that your body can reject the cadaver. Sure that is unlikely, but it also takes longer for that cadaver to adapt to your body. That results in a later date for walking which also means a stretched out PT schedule.
Old     (Slaytwebeling)      Join Date: Nov 2011       10-15-2014, 7:18 PM Reply   
Eraced- Who is doing your surgery? I had Mark Addickes at memorial Herman. I had patellar and the way he explained it to me is that it takes longer to heal/more painful but it is the what he recommends for athletes.
Old     (jww)      Join Date: Oct 2013       10-15-2014, 7:30 PM Reply   
Evan, the reasons why i'd go with cadaver, if I had to do it again... 1. i did not / do not like how the hamstring graft feels after... it still feels funny to me... 2. the cadaver graft process has really improved... my next door neighbor is an ortho and he would do the cadaver if/when his acl goes because of the improvements in the grafting 3. lots of of my friends have had the cadaver from different doctors and their recovery and strength was impressive.

Pretty common injury and we all have friends that have gone through it... pro and cons and opinions.... I rarely give my opinion, but i have some personal regret not researching what is actually done in each of the grafting processes... i think if someone would have walked me through the details of the hamstring graft or if i would have actually done my homework in advance... i would have made a different decision.

It seems like you are doing your homework and the decision you make will be the right one for you.

Wish you the best of luck with the graft, surgery and recovery.
Old     (captain_vilfo)      Join Date: Apr 2007       10-16-2014, 10:24 AM Reply   
I had the patellar graft in aug of 09, didnt ride until may the following year (with a brace obviously). The extended period of time was due more of the cold weather in NY rather than the recovery process.

Regardless of what you get you gotta fall in love with the rehab and hit it hard. I became best friends with stretching and the bike and still to this day make sure I never skips legs at the gym. I ride with a brace behind the boat only because I dont notice it and for the added protection it gives me physically/mentally but at the cable I dont bother.

In regards for type of surgery this is what I've read and what my othropedic surgeon told me:

Cadaver: quickest recovery, potentially weakest graft
Patellar: longer rehab than cadaver, middle strength graft
Hamstring: longest recovery, strongest graft

With either the patellar or hamstring your new ACL will become stronger than your previous after 1.5yrs post-op if you put in the work for the muscles surronding it.
Old     (gnarslayer)      Join Date: Sep 2008       10-17-2014, 8:20 AM Reply   
I had the patella graft about 6 years ago, and felt fully recovered by 6 months easily, if not earlier. Felt like I was riding 100% at 6 months, took off the brace at 1 year. Never looked back.

I feel like ACL injury isn't as big of a deal as people make it out to be. Rehab is key and you will come back stronger than ever.
Old     (Orange)      Join Date: Jun 2012       10-17-2014, 7:59 PM Reply   
Quote:
Originally Posted by gnarslayer View Post
I feel like ACL injury isn't as big of a deal as people make it out to be. Rehab is key and you will come back stronger than ever.
Totally agree from a long-term perspective. In the short-term, however, it's a big deal. It turns your world upside down for a couple months, severely limits your activity for a couple more. At around 6-8 months you can resume a lot of stuff and while you're aware of it, you can still have fun with most activities you normally do. Somewhere in the 10-14 month range it's like it never happened. There's no denying, however, that in that 2-3 month period between the injury and regaining some basic mobility (like putting on pants without having to think about how you do it) it seems like a big deal at the time.
Old     (ERaced)      Join Date: Jun 2014       10-20-2014, 2:55 PM Reply   
Thanks for all the input guys! I'll be going with the petalla graft. Getting things done in November. Thank god for health insurance though, already $1400 into the knee and haven't even had the surgery yet. Just glad I tore it at the end of the season. I'll let y'all know how it goes.
Old     (liquidmx)      Join Date: Jun 2005       10-31-2014, 9:52 AM Reply   
Hey Evan. A few pointers on recovery (as alluded by Gnarslayer and Orange):

First: give it a LOT of time to recover. It may feel good at 6-9 mos but take it easy. I used this period to dial in my switch stuff and fill in a lot of basics my riding was missing.

Second: get a brace. My surgeon (like most) thought he was God. No brace needed, his work was flawless (and he had the reputation to back it up). I didn't care and got a CTI custom brace. If you have good insurance it should be cheaper than a new board...and is worth every penny IMHO.

Third: learn to love that passive motion machine and the ice chest cooler thing (if they still use those?). I was on that damn passive machine 6-8 hours a DAY and had the ice going non-stop too (massive bruising on my shin as a result). Both the surgeon and PT were really impressed at the range of motion and lack of swelling and that combination expedited the PT process. Additionally I was able to spin bike (before surgery to help counteract the atrophy in the muscle). Since most of us use surgeons who are sports based they have access to local steroid injections. My guy asked if I wanted one and I said hell yah. To this day I cannot build the knee area of my other quad to the same size as the injured one due to the PT and (likely) steroid help (I am not sure about hamstrings as that's hard to compare).

Lastly: If you are a big sports guy be prepared to realize your other knee isn't as solid as you thought. A good cleaned up knee with a tight ACL, proper PT, recovery and strength training will quickly show you that your other knee was not in the shape you thought it was.
Old     (tonyv420)      Join Date: Jul 2007       10-31-2014, 10:42 AM Reply   
I was riding 4 months after my cadaver graft, with a brace
Old     (lfadam)      Join Date: Nov 2008       10-31-2014, 12:04 PM Reply   
I went patellar as well and had my surgery in November so maybe you'll find my timetable useful.

I tore my ACL June 22, 2012 and had my surgery November 15th, 2012 (had to wait because of a blood clot issue)
I had a complication and had another minor surgery around December 20th, 2012.
By March I was running
By April 15th (4 months post-op) I was on a board riding and doing small jumps.
By May 15th I was able to do my normal assortment of tricks (inverts, 3s, 5s) riding with a brace and avoiding long sets/going into the flats/double ups.

I went really hard at PT but even I was shocked at how fast they had me running and riding. If I didn't have complications, it may have been even faster. Just work hard. I will say my biggest mistake is that after May 15th, I assumed I was good to go and stopped PT and most weight lifting so I could wakeboard. My repaired leg was significantly smaller than my good leg (I mean, probably 60-70% of the size of my right leg!) I'm no doctor but I'm pretty sure this messed up my back. I've been having a lot of back issues the last 2 years and I think it's because I was always favoring my strong leg a little bit. It took probably 1-1.5 years for my left leg to be comparable in size to my right, and it's still probably a hair smaller to this day. However, it's now strong enough that I feel confident riding without a brace. Regardless, that's one of my winter goals (to get my legs huge, and more importantly, equal).

Good luck!
Old     (cjobil43)      Join Date: Dec 2013       11-18-2014, 10:19 PM Reply   
I was in the same boat as you. I tore my acl, and I had a month to decide which graft. I did TONS of research, using my universities extensive research library, as well as the Internet and forums. All I can tell you is do not base your decisons off of specific individual's testimony. You must understand that almost everyone is biased to what they chose. Someone convinced them along the line that the option they chose was the best options. Unfortunately, many people are just plan misinformed when it comes to graft options, and they chose out of sheer ignorance.

In my case (again just use this as a subjective example), after all the hours of research, discussing my options with 2 doctors (one who solely did patellas, and one who solely did hamstring), and making an "informed decision," I chose hamstring. 8 months later, I re-tore it. Second time around, I chose patella, and what a different experience.

Ask anyone who knows what they are talking about, for example the really involved doctors who do hundreds of acl reconstructions each year, the ones who write the rules, the ones who operate on multi million dollar athletes, there is no discussion. Patella graft is superior in almost every catagory.

One final note, the magnitude of pain you will feel with the hamstring graft is incredible. The nerve block used by surgeons for this operation only blocks the top half of the knee. This is good for the actual reconstruction because it will block pain from the drilling, anchoring, ect. (It also blocks pain from the harvest site of the patella.) What it does not cover is the lower inside portion of your thigh, ur hamstring, and the harvest site will burn with the fire of a thousand suns. That being said, it was only excruciating for 2 or 3 days, but compare that to almost NO pain with my patella graft!

I'm back now to almost 100% and my knee feels much more stable through the entire process this time around. Something about that hamstring graft, as mentioned above, just didn't feel right. A large part of me is happy I re-tore so soon, while I was young, and could just continue on with my PT for a second time, although again, with much better results.

Good luck, and if you really want to learn more, read up on Dr. James andrews, and his procedures and methods. He is THE WORLDWIDE AUTHORITY on acl reconstructiom. He is the man!
Old     (trayson)      Join Date: May 2013       11-19-2014, 3:47 PM Reply   
My wife tore hers during last ski season in April and had her ACL reconstruction surgery in May, right at the window where swelling had gone down enough to make it plausible. Her surgeon was awesome and she did hamstring.

I think it's worth noting that not only is there the ACL stuff, but also you might factor in other damage that happened. In her case, there was a lot of meniscus damage. She is going to be released to ski again in January, but had to take the entire summer off from any sports. We have fantastic insurance and physical therapy has been liberal since it's all 100% covered.

That said, the only thing I have to contribute on the subject is that per her surgeon there is no difference in re-injury rates based on using a brace vs no-brace afterwards. Yes, many will swear by one, but according to her surgeon, there's really nothing to back up whether it's an effective preventer or re-injury or not.

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