* KNEE Surgery - Need your input *

2 weeks ago my wife and I were out riding. She was just getting the hang of things and getting very close going wake to wake. She cased the second wake and went down. She said that her knee was hurting pretty bad (she didn't shed any tears).

Ended up finding out that she tore her ACL, MCL, and the meniscus cartilage. She has surgery next week and they are going to graph from her hamstring to replace the ACL. After surgery the doc said she would have to go through rehab and that she would have to wear a brace for sports afterwards.

Any input on the surgery, rehab, and what braces are good for wakeboarding and sports in general would be much appreciated.

Thanks everyone.

If you are looking for general info on knee surgery from users, I'd do a search on this site and the other big wakeboarding site. I know I've seen it discussed a lot here, there, or in both places. I also recall a 5-part first-hand article on the subject on one of these sites.

Check into the Allograft (rather than hamstring graft)...I had it done...
The recovery is much easier and faster.
I was off crutches in 3 days, riding again in 4.5 months, jumping again in 6... and rehab was actually pretty easy (and I'm a sissy when it comes to pain). Along with faster recovery is the strength issue. The allograft is doubled over and thus twice as strong as the original ACL.

I had my ACL / MCL injury a year ago in Aug. I had surgury back in Jan (I had to wait for the MCL to heal on it's own - it wasn't torn completely). I have talked to loads of people about their surgeries...one thing I hear a lot of is that people who had the hamstring & Patellar grafts wished they had done the allograft. It's worth checking into...even if you need to travel to a larger city.

What exactly is an Allograft? What's the procedure?

It is a graft from a cadaver. The tissue is irradiated so that there is no rejection. Simply put the procedure is to drill a hole in the femur and loop the graft through the hole and anchor both ends to the top of the shin.

Go to a doctor who works on a local pro-sports team or handles the Athletic Department for a Division I school. Not all orthopedic surgeons are the same. Some of them work miracles while others totally suck. If a doctor works on a lot of "valuable knees", he's probably pretty good.

Yeah, the doctor mentioned doing a graft from a cadaver. However, he said he would suggest the hamstring graft because it's your own. He did mention that there is a very slight minimal chance of rejection when doing a cadaver, but it's not very common. Do you know if the allograft stronger than the hamstring graft? My wife have been trying to decide whether to do the Allograft or Hamstring graft - what were the pros and cons for you?

Well, not to sound cliché but the rejection is about 1 in a million from everything I have read and been told. So I thought is sounded pretty safe. I went with the allograft, really not knowing much about it, just that my Dr recommended it. My doc was an Olympic Ski team Dr as well as currently working with for several local pro teams. (Matt is right on with the "Valuable knee" comment). He said it was all about the least amount of trauma and the fastest recovery times. As I read more and talked to people on this board, I got really comfortable with the idea (again I had almost 6 months to do so).

As for strength...This is what the pro athletes are doing...so it has got to be pretty strong.

Cons...really the inverse of everything I just said. More pain (in more areas), slower recovery times, bigger scars.

Matt - I agree about the "valuable knees" that's definitely a good way to find a good doctor.

Greg - Thanks for your input. The one thing I don't like about the hamstring graft is that you are taking from something that was totally fine before.

I have had both done (Hamstring and Allograft), and would HIGHLY recommend the Allograft. I can't stress that highly enough, the difference was night and day. With the hamstring graft, it took me much longer to get into a position where I felt comfortable riding again. To me, it took much longer to get my leg muscles back into shape, especially my hamstring (for obvious reasons). It took me almost a year to get to the level I was at before surgery, and I did not slouch on my rehab. The knee still gives me some problems to this day (almost 5 years after surgery), and I still don't feel comfortable playing any kind of sports without a brace on it.

I had the Allograft done on my other knee, which I blew out 3 years ago, and I couldn't believe the difference. I was back and riding at my previous level by the six month mark, and the knee feels perfect. The only thing I use a brace for is wakeboarding, and that is more of a precaution to make me feel better than an actual need.

Pete

Pete - Thanks for the feed back. Now I am trying to figure out if she should do an Allograft or Hamstring. Both you and Gregg are making me lean towards the Allograft.

Anyone else out there with their input as to which one we should choose, pros and cons. Thanks again.

Why wasn't the Patella tendon graft an option for your wife? The Bone-on-Bone healing process is better than the Screw fixation that's needed with the Allograft. Does/did she have lateral tracking problems with her kneecap? Which is most reasons for not using the Patella tendon autograft.
The Allograft is usually the Achilles Tendon from the cadaver....and the recovery time is usually quicker than the Autograft.

Phantom5815 - actually it was but the doc said he recommends the hamstring for her. He mentioned the Patella can be more painful, leave a bigger scar (cosmetic), and can cause more issues down the road when bending down on your knees (sitting/standing on your knees) and putting pressure on them.

Gold Standard for ACL repairs is using the Patella tendon Graft....unless there are extenuating circumstances.
I personally would not opt for the Hamstring Autograft, since you will need the Hamstrings to help with the rehab.
Since I did tear my ACL in '95,I've opted not to have any reconstruction done. I was back to playing at the level 6mos after the injury
But that's just me.

(Message edited by phantom5815 on September 08, 2003)

Phillip - here's some info I pulled off the Mayo Clinic website about using different graft sites for the reconstruction.

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As a result surgical treatment involves reconstructing the ACL by replacing it with another tendon (graft). An autograft uses a tendon from your own body, while an allograft (cadaver graft) uses a tendon from another person.

The procedure used most commonly is a patellar tendon graft. A portion of your patellar tendon — the wide tendon that connects the kneecap to the tibia — is used to replace the ACL.


Pros and cons of different grafts

In some cases, the graft may be taken from your hamstring tendon instead of the patellar tendon. Hamstrings are the muscles on the back of your thigh. Current research shows that using the hamstring tendon as a replacement works just as well as using the patellar tendon. Some research has shown a small difference in looseness in the knees of people who have the hamstring graft operation. But this does not appear to affect performance in most people who have the hamstring graft surgery.

If, because of your age or other reasons, your own tendons do not provide the best replacement for the injured ligament, your doctor may recommend an allograft. In some cases, it may be better to use a younger, stronger allograft tendon than to use your own tendon. One benefit of an allograft is that recovery from surgery is usually easier, faster and less painful since you do not have the recovery associated with the removal of the tendon used for the graft.

Allografts are taken from cadavers that have been carefully screened and tested. As a result the risk of disease transmission is very small. The risk of contracting the human immunodeficiency virus (HIV) or hepatitis from an allograft is estimated to be 1 in 1.6 million.

Some types of synthetic grafts have been tried, but none has been successful to date. Because these synthetic grafts have a high failure rate, avoid them.

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Hope this helps.

In case you missed it, there is a 6 part series of articles about ACL surgery here on Wakeworld:
http://www.wakeworld.com/articles/2002/acl1.asp

As far as getting back and riding, just look at Danny Harf as an example - won the X Games just 9 months after having ACL surgery (almost positive it was allograft). Shane Bonifay also had ACL surgery last October.

The rehab is really important for a full recovery. She needs to be really good about doing the exercises and working to strengthen the leg. A friend of my had the patellar tendon graft done about 5 years ago and he wakeboards, snowboards, and mtn bikes without needing a brace. He says that the repaired knee actually feels stronger than the other one.

Good luck with her surgery and recovery.

I just had my ACL repaired about two weeks ago and went with a patellar tendon graft. I think everyone is missing the point that all grafts are of relative strength during the first six weeks, but then they transform into ligaments which are a bit weaker. Its actually from the sixth - twelvth week that the new graft is the weakest.

Thanks you guys, that is some good info. Yeah, I agree that rehab is really important - she is already doing some rehab and exercises prior to the surgery to get full mobility in her knee since the meniscus cartilage is lodged in the knee preventing it to fully extend.

Just had mine done yesterday. Torn ACL, partially torn MCL, and some lateral meniscus damage. Hamstring Autograft was the best option for me. It all depends on your personal situation and what your doc has had the best experience with.

I'm currently kicking it on my sleeper sofa, hooked up to Polar Care and a Continuous Passive Motion device (highly recommend!), taking some pain meds and I'm pretty comfortable. Only thing that is a little sore is my hamstring, but I'm still able to bear weight. Definitely feeling better than I thought I would be at this point.

Lindsay - I'm glad to hear everything is going well for you. I have heard that the Polar Care is a must, everyone who has used one has said so. Your knee situation sounds exactly like my wifes. I'm sure my wife will appreciate hearing about another girl in same situation. Thanks for your post and good luck!

If she has specific questions or just wants to commiserate with someone, feel free to have her email me... ll_wazzu_coug@yahoo.com

Hope she is feeling OK about everything and good luck to you both. She will definitely be needing your assistance that first week.

my fiancee had the patella graft. like everyone says, get an orth surgeon who does knees, does sport injuries, and does pro or college sports. Rehab is going well, will be good to soon.

Had ACL reconstruction last year and chose to use my hamstring. Very highly recommended as it causes less atrophy to the quads. The only downside is the time and effort to have the hamstring heal. However, I was playing hockey 5 months later. Very quick recovery. I was scared away from the allograft because a couple of weeks before a guy from the same state as me died when the tissue that was used was found to have a disease and there was no cure. I figure better your own tissue than to take a chance even if it is very small. After all, there is still a chance.

The ACL question was covered pretty well. I had the pattela tendon version done in January of 1995 and the knee pain you mentioned was gone by mid 1997. One thing nice about the pain of a pattella graph, is that it holds you back and allows for a smaller chance of injuring the graph. Silly reason to put up with pain, but I did not have the hamstring option in 1995.

Brace: I am a big believer in the CTI brace because of the service that they offer. I still have the same brace since 1995 and its been rebuilt 4 times at only $150 each time, each time taking less than 4 days. A CTI brace will be the only one you will ever need. I have other friends that have gone through several braces over the years at $500-$1200 apiece.

I just had a cadaver put in 3 weeks ago today and i missed two days of work and rode my landlock last night!!! very fast recovery time. I also had meniscal repair at the same time!

First day home from the hospital...she had her surgery yesterday. It took 3 hours and everything went PERFECT according to the Doc. She decided to do the hamstring graft. So far so good, she's not in any pain, just a little discomfort. Tomorrow (Friday) is her first session of physical therapy. Now she's on the road to recovery and hopefully be back to doing some riding.

I just want to thank all of you for your support and input. We really appreciate it.

~Later~

I just damaged my knee on Sunday and went to my family doc. on Tuesday, and he said that i did not damage my ACL or MCL, but i have less movement
in my knee know.
My question is it possible to damage my meniscus and nothing else?
And what are the symptoms?
Also is it normal for the doc to say call me in a week. If it's not any better then we will do an MRI?

All great info. Apreciate the input. I go in on Thurs the 2nd of Oct. Blown acl/mcl thanks to riding motocross. Screw motocross....dirt bad, water good.

Jeff E, that is normal for the doc to say what he did, especially if he does not suspect any major tears. The first time I hurt my knee my doc said it was probably not an ACL tear because my knee was not "loose." He said to give it a couple of weeks, and if it doesn't get better to come back and do an MRI. It actually got a little worse, mostly walking up and down stairs, so I did end up having an MRI and it was just some torn cartilage under my kneecap.
If you have less movement in your knee it could just be because of swelling. When you have a lot of fluid build up it is much harder to bend/extend completely.