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      05-04-2014, 08:12 AM   #1
blinkme323
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Torn ACL - Graft Options?

Hey everyone, a few weeks ago I landed awkwardly playing basketball and twisted my knee. Well a few days and lots of pain later, I found out that I have a fully torn acl and partial tears to both menisci.

I'm currently leaning towards the allograft as I'm not a fan of harvesting a graft from my own body and weakening another area. I was just curious as to what your thoughts were on choice of grafts? Per my doctor, advances have made the main three graft choices pretty much on the same playing field.
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      05-04-2014, 08:41 AM   #2
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I had the graft from my patelar tendon. Haven't had any issue, and I do heavyish squats and work out regularly. Depending on the meniscus tear you have could cause issue down the road. For me they had to cut out about 2/3rds of it leaving me with bone on bone. It can get sore fairly easy with excess walking primarily being the cause.
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      05-04-2014, 09:12 AM   #3
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I tore my meniscus playing football 12 years ago. My doctor actually drilled my bone to induce bleeding so it will regenerate cartilage. I haven't had any issues since. But every time i play any sports I always wear a brace, just to make sure I dont tweak it again.
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      05-04-2014, 10:12 AM   #4
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I have torn my ACL 3 times and had surgery twice. I tore my left ACL first playing flag football then on the first day back to playing flag, I tore my right one but this time it was the ACL, MCL and Meniscus. Had that repaired then the first season back to playing basketball, I tore my left again. They were ALL freak accidents and not the workmanship. I play aggressively in all competitive sports so I take full blame. The last tear of my left ACL was me trying to drive through two giants...I lost that battle. I actually have not repaired my left ACL and have been playing flag football, basketball, softball, snow boarding, etc. with just my Townsend brace. So you could wait on the surgery if you want but if you are young, I say go for it and get it repaired. I am 34 and able to do what I do at 95% with a brace and torn left ACL. You do need to have a strong quadricep to stabilize the knee.

With all that said, I went with a ligament from a cadaver. I didn't want to take it from my hamstring because I felt like the hamstring was already a weak muscle that it would never feel the same again. I know there is a chance that the cadaver ligament does not take and takes longer for it to acclimate to your body but for me...it was the right decision.

I would just talk to your doctor and discuss the options and what their experience is. Maybe they have a specific suggestion.

GL man!
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      05-04-2014, 06:50 PM   #5
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Middle third patellar substitution for the ACL is what I would go with. Works well when used with femoral and tibial bone plugs. Low recovery time, perfect match as it's your equipment, and fairly quick procedure. Difficulty of recovery is optimal as well.

Discuss your options with your surgeon!
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      05-05-2014, 12:29 AM   #6
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All the options work very well.

Surprisingly the hamstrings grow back per a study done in Europe where volunteers had exploratory surgery 7 months after surgery.

I offer my patients both options and let them decide.
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      05-05-2014, 09:10 AM   #7
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Thanks for insight thus far guys. As for what the surgeon recommended for the graft, well he didn't really make one. He basically said that they all have their plusses and minuses and that there really isn't a "bad choice" among the three.

The interesting wrinkle here is that I'm fairly certain that my ACL has at leats been partially torn for a number of years now, but I just (stupidly) played through it. Being that as it may, my thinking is that any graft would be an improvment over what I've had for the past x amount of years.
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      05-05-2014, 12:05 PM   #8
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I had my hamstring grafted 3 years ago to repair my ACL. My knee is sturdy, but when really pushing myself, I'll sometimes feel weakness almost cramplike feeling in the hamstring.

It seems to be less lately as I consciously try to improve hamstring strength.
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      05-05-2014, 05:50 PM   #9
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Quote:
Originally Posted by FrankieZ4 View Post
I had my hamstring grafted 3 years ago to repair my ACL. My knee is sturdy, but when really pushing myself, I'll sometimes feel weakness almost cramplike feeling in the hamstring.

It seems to be less lately as I consciously try to improve hamstring strength.
This is exactly what my brother feels from time to time. He also tore his ACL years ago and had the hamstring graft. He said that it has never fully healed and feels like its at 90%.

Granted there may be many causes of this...maybe poor rehab, etc.
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      05-12-2014, 08:21 PM   #10
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Thanks again for the comments guys. Any advice as to how long I might be on crutches for? The doctor said that it depends on how the meniscus looks, but it could be anywhere from a one week to six, so not much help there.
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      05-12-2014, 10:28 PM   #11
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Quote:
Originally Posted by blinkme323 View Post
Thanks again for the comments guys. Any advice as to how long I might be on crutches for? The doctor said that it depends on how the meniscus looks, but it could be anywhere from a one week to six, so not much help there.
they told me couple weeks on crutches but i played golf in hawaii 3-4 weeks later. being careful of course and also was back in the gym later that week. just doing upper body stuff. it wasnt too bad except sleeping was a pain for a while.
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      05-12-2014, 11:43 PM   #12
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Tore my ACL and my Minuscus in my right knee back in 2009 playing soccer. Had surgery and guess what, it's 60% torn again playing flag football. Having surgery in July, hopefully. I'd go with doing a tendon from your own body. Personally, I'm more comfortable wit ha tendon from my own body.
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      05-12-2014, 11:46 PM   #13
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Quote:
Originally Posted by ShocknAwe View Post
Middle third patellar substitution for the ACL is what I would go with. Works well when used with femoral and tibial bone plugs. Low recovery time, perfect match as it's your equipment, and fairly quick procedure. Difficulty of recovery is optimal as well.

Discuss your options with your surgeon!
+1

Patellar tendon is usually the first choice. Hamstring second. Patients that tore the replacement several times eventually tried the cadaver route.
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      05-13-2014, 12:16 PM   #14
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Torn my ACL last September, got my surgery earlier this year in February. Doctor offered all 3 with the order of recommendation: hamstring, patellar, allograft. While patellar seems to offer the closest strength match to an untorn ACL, seems like knee pain is a hit or miss thing. It does offer a faster recovery than Hamstring graft, though. Hamstring graft, you are less likely to experience pain but recovery is much slower since your hamstring isn't ever going to be 100%. I do see some research suggesting hamstring will grow back. I'm 3 month into my post-op now, I feel like pre- and post-op rehab will be the most critical part of how fast you recover. I was on crutches for 3 weeks, but I had no meniscus damage. I did have a minor tear from snowboard 2 years ago, though.
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      05-14-2014, 09:54 AM   #15
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Interesting insight on the grafts guys, thanks. I think I'm leaning towards the allograft for a few reasons

1) I'm fairly certain I have been living / playing ball with at least a partial ACL tear for a few years now, so ANY of the options would absolutely be an upgrade over that, lol.

2) Being 31 (I know it's not THAT old, but still) I'd prefer not to weaken another area to accomodate the ACL.

3) My doctor said that recent studies have shown that all three options have shown to essentially be the same after a period of time (I'm highly paraphrasing here).
----------------

That being said, all three do seem to have their own merits, but that is my thought process. Surgery currently scheduled for the 19th!
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