ACL / Partial tear of the Miniscus -back lateral part

I have given DRmark some grief about how much time he spends on these blogs but after 6 days now of serious down time myself with rescent reconstruction of my own knee, I am learning that Drmark has some really good beta and seems to have some really good first hand accounts, all whom are writting on this blog after they have seen him personally.

I am on a constant to continue finding good beta about my own knee and how to get back on it ASAP. I know it is not a race to recover, however.

I am curious about the rehab you would have someone going though after a cadavor allo graph patella tendon with bone on both ends and a slight tear of the Back lateral miniscus.

I have read opinions on the graphs for months prior to getting my own along with what my wife went through the past two years. We dont need to get into that one. Everyone has an opinion on graphs. It really is crazy how many Dr's say so many different things and give so many options when researching about what you should do.

Your advice has been very good to many here and I am really curious about rehab given I have a small miniscus tear. I have be given 2 weeks non weight (well 25% but thats only really balance). And then at 2 weeks I think I will go to much more. ROM is great, no pain etc. I have been given everything as I have asked for it (CPM machine, Great icing, PT every day, but only stem (IFC and russian) along with a ton of leg lifts in every direction, etc....

Really curious what you think or anyone else with experience for rehab....?

Thanks

AKTAHOE1 (Kevin Quinn)

I have been sucessfully trying to ignore the lateral meniscus when I do ACL work for many years. So far, I have had to rescope one patient (workman's comp, obvioiusly) in the past 20 years for lateral mensical tears.

Here is a good reference on this issue

http://www.ncbi.nlm.nih.gov/pubmed/7778698


We would have a lateral meniscal tear, treated with suture repair, benign neglect, or partial menisectomy weight bear as tolerated, and do their flexion exercises. Meniscal suture repairs shouldn't do squats at greater than 90 degrees of flexion, but no one should anyway (assuming they aren't looking forward to more knee surgery).

Our aggressive rehab plan is probably not appropriate for low strength ACL grafts though, but we won't get into that now. Its been so long since I did a cadaver reconstruction I don't know if a brace, crutches, or partial weight bearing is still reccommended. When I was doing them, the only modification I made was prohibiting return to cutting and pivoting sports for one solid year. During that time an allograft patient was allowed to do anything they wanted to do on the machines in the health club-but no more. Despite that many guys returned to sports before, and I got to do it all over again. Thats how my distaste for allos came about.

NCBI is a site I have been all over along with others. Great link!

I was treated with a small suture repair and told basically the same. They do not want me to go more than 90 in my rehab for the next two weeks, however I know that I could. Weight is 25% but I could do more for certain. I realize the miniscus needs to heal.

I am curious why you consider my graph such a low strength repair? Bone on both ends, wait for it to calcify, the cells need to grow, however, I dont believe this to be a soft tissue graph, so I have been told over and over. I have looked over and over and think I understand the deal with a soft tissue graph. My wife had a tibialious postierior (that would be a soft tissue graph correct? Or like getting an achilies would be soft as well) for her graph two years ago and then thought she did it again one year later same knee while filming doing stupid things, not due to the type of graph. The graph actually held up good. Only a bit of heal and response was needed and at that time she did her miniscus. So that was the concern.

A year plus out know from that and she is firing on all cylanders again. She is a world class tri athlete / action sport athlete and competes at a very high level. Her knee could not be better. She runs more than a horse. It seems as though the majority of people we deal with here in Tahoe all get the allo over auto, per our Dr's here....Again, I know the deal with all the opinions, etc.

You deal with moto guys a ton. talking with several that are associates, T Pastrana, Metz and others that have done there knees it seems they go 50/50 as well. All have done it so many times with other complications but agian the graphs are 50/50 on what they get.

Now there is a guy in pittsburg who thinks the double bundle is the way to go....whatever....

I have a allo graph by recommendation, like the majority here that I am around. Not that it matters, but all of these people are either world cup skiers, athletes for TGR or Matchstick or up and coming ski racing or film stars. Again that doesnt matter who they are, but point is these folks are going for it in there everyday life. All of them are having zero compilcations....again I only know this as I am in contact with these people almost daily here in tahoe and due to the nature of my business.

I value everyones opinion and curious with my graph imparticular, given the miniscus and location, is non weight bearing for 2 weeks a good thing?

I know the more I can do, the better. As with all of us, we just do not want anytime to pass me by or rip the stich. I was also told the CPM machine is good to just keep the blood flowing. Had I only done the ACL I would not have gotten the CPM machine. I do know they have utilized it in the past for full knee repairs. ACL's only as of late, its up the the patient...correct?

I am Purely trying to learn and educate myself as much as possile.

Thanks

Its a low strength graft because it is dead, and comes back to life slowly, assumng its not rejected. (Yes rejection is something we know little about, but it happens). During that first year to 18 months its vulnerable.

Your own tendon is as strong as the ligament and the tendon cells stay alive inside nourished by the synovial fluid. Obviously rejection isn't in the mix, and the ligamentization process occurs far more rapidly.
These are facts that no one disputes.

An allograft can be installed through a tiny, less than one inch incision.

Nowadays most of the docs measure their manhood by the inverse of the length of their incisions.

I measure my manhood by the inverse of the time it takes an athlete to return to sports and the inverse of the number of operations necessary in that athlete's lifetime.

i had an acl hamstring recon and lateral meniscus repair apr 7 of this year. i was 50% weight bearing for 6 weeks. been off crutches for 2 weeks.

best rehab advice - focus on extension and get it back quickly. do heel slides for extension like its your job--the sooner you get back to 110-120, the sooner you can ride a bike. if you are partial or non weight bearing do as much as you can to reduce the atrophy of quad muscle. do quad sets, straight leg raises as much as you can tolerate. this muscle is extremely easy to lose and very difficult to get back as i am finding out now.

Good luck!

I have had to ACL reconstruction in both knees. The right in 2007 and the left 2010. The right one, I obliterated my acl, tore my lateral meniscus, and a buckle handle tear of my cartilage. It was repaired by a bone paterlla graph. My physical therapy lasted about five months going two times a week. I had a hard time bending, but was at full extention in a week.
The left one, i again obliterated my acl, tore my MCL, LCL, medial and lateral meniscus, and my PCL has laxity. This time my ACL was repaired by my hamstring tendon. My physical therapy was shorter this time I only spent three months in therapy going two weeks, three times a day and the rest two to one, but this time i was put in a knee immobilizer after surgery for three to four weeks and then a donjoy brace for the next 7 months. During therapy I had a hard time straightening, but was at full flexsion in about a month.
In my opinion I like the bone patellar graph better. yes it took longer in therapy but I don't have a problem with my hamstrings. With the hamstring tendon reconstruction, I am still have a huge amount of pain and still having a hard time keeping my knee at full extension. It also seems that my knee gets stiffer sooner. This could be because it only 18 weeks old. The only other place that I have pain is on the left side of my left knee, but this pain is due to a car accident I had at 14 weeks where my knee with through the glove box and broke the handle. It is doing better now but my hamstrings just hurt.
If I could go back on this surgery I would have rather had the bone patellar graph.

Hey, Kevin - I retore a meniscus repair Doc Orr did on me four months after surgery. I was just about to go get prolozone therapy on it when I ripped it and ended up with a world of grief when the doc took 60% of it out. I would highly recommend some prolozone into that area to accelerate and promote growth and healing before you get back on it...

Hello Jennifer,


I know of someone with a very similar problem who was successfully treated by a medical office in New York. Also, you should do some research on Prolozone. You can call them at 718-544-1444 or 845-425-7997. They were really amazed with the results.