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I came across a report from The American Orthopaedic Society for Sports Medicine titled "Allografts for ACL Reconstruction Survey Report" dated July 1, 2013.
http://www.sportsmed.org/uploadedFil...n%20Survey.pdf
Opinions on allograft for ACL repair in an acrive 47 yo weekend warrior type, back-country tele-skier?
just had the surgery a little over two weeks ago. went btb patellar autograft. doc said, given my lifestyle (ski, ball, tennis, plyos), that i require the "gold standard." pretty high profile doc (did tom brady, blake griffin, etc.), so i went with him. whatever you do, get a second and even third opinion to get yourself in that comfortable place with your chosen doc.
Famid
I had btb patellar autograft on my left knee 20 years ago, and that knee is perfect (I think) although my current doc said there is some play. I've done 4 marathons on that knee, but I have to admit, the only harsh treatment the knees get is from skiing. I don't play basketball, tennis, volleyball, etc.
Allograft has me worried. I will seek a 2nd opinion, but I have surgery scheduled for April 16. Current doc does other procedures too, so I need to have more of a tlk with him I was so dumbfounded today when we viewed my MRI, I was at a loss. Didn't think I did an ACL.
Steadman did allograft on Owen, pro football (soccer) player, so seems that allograft is suitable for the younger patient, which is what my OS told me - I dont have ACL issues though, just meniscus
http://ortho.com.sg/main/allograft-acl-reconstructions/
There is a higher failure rate with allograft in younger athletes. You no longer qualify as "younger," so it is a viable option.
Yeah, I know I'm in the Adult recreational athelete population now!
So is the expectation that even though I blew out the ACL skiing, the allograft is OK for me because the skiing of a 47 year old is supposed to be less aggressive than that of a 25 yo?
I mean, I've blew L & R ACLs now, both skiing. I don't do any other high ACL demand sports, but I've demonstrated the ablity to push the limits of my OEM ACL. Shouldn't I worry about teh allograft?
One thing to toss out is the allograft usually has a longer recovery period. My wife had tried to have an autograft last year but is too tiny an her hamstring only gave about 2/3 the size the surgeon wanted so it was supplemented by an allograft. This made her recovery period noticeably longer. It felt fine for her but the surgeon asked her to refrain from a lot of activity for at least 9 months. Almost at the one year mark and it seems fully recovered and ready to go. She's only a couple of years younger than you and wanted the auto after consulting with surgeon.
Hmm, that is another concern I'm starting to have. I'm reading about the considerably longer time away from sports, but my surgeon is saying I'll start running at 3 months. Obviously not running seriously or high mielage, but that seems excessively short time for an allograft.
^^^^
As I understood it at the time of my ACL repair (hamstring), the introduced tissue weakens after surgery until the new blood flow is introduced and it rejuvenates. 3 months was supposedly the weakest point in my recovery, though I was hiking and biking in a month after surgery. Skiing in 6.
The HEALING time from surgery is significantly shorter with an allograft. Less pain post-op, quicker to return to walking/jogging/running. The RECOVERY time for an allograft- how long it will take to return to full contact sports or in this case skiing is longer, 9-12+ months. It takes longer for re-innervation of blood flow and scaffold stabilization with an allograft. In active individuals, this creates a window to mess up all of that hard work that went into rehab, as one feels stronger than the knee really is in the 6-12 month period.Quote:
Originally Posted by meatball66
Some of us learned this the hard way.
Allograft ACL graft at age 46 or so (along with microfracture) - also a tele skier - VERY happy with results. It's long past now and of course I didn't have an autograft on the other knee make a valid comparison. But I viewed the allograft as an upgrade to OEM - bigger piece of tissue than the ACL it replaced. I took rehab seriously and was back on skis 6 months post-op. Felt strong that first season post op but in hindsight proprioception (sp?) was less than optimal. Second season and many more, it's better than new.
Great data points, I appreciate the info! Welcome more stories!
Hi there,Quote:
Originally Posted by meatball66
I gave my view to you on a different thread but found you again here - so I will add two cents more: We are about the same age (i turn 50 in May), tele skiers, athletic. ACL injury due to tele skiing 6 weeks ago.
I agonized over the decision of which graft. 2 weeks ago i decided and rolled the dice with patellar tendon because to just seems that, given all the various pro's and cons, getting the patellar tendon is the best insurance for an athletic and fun future of telemark skiing, outdoor stuff, martial arts, yoga. I felt that with cadaver I would always be wondering and doubting if i made the right choice... so despite the short term hardship of more pain, and the risk of knee pain or numbness, I think patellar tendon is the way to go, and t do it with a great surgeon who has done a ton of them! Cheers!
Acl allograft in my r knee probably 13 years ago when I was 26. Done by Dr Dudley Ferrari at umass medical, he was team ortho for the red sox and celtics, did mark mcguires knee. Discussion with doc was your a vert skater, you wakeboard and snowboard, dont want to weaken your knee in another aspect or risk patellar tendonitis so allograft is a good option. He shopped around and got me a good tendon from a young man. Recovery was very fast. Back at work in a week, back on a skateboard in 3 months, snowboarding with no brace the following winter. Took my rehab serious. Im now pushing 40 been on skis now for the last 3 years and ski pretty hard, stepping it up bigger and bigger each year, Acl still tight and fully intact according to my ortho. Leg is strong and flexible, I can touch my heel to my butt, no pain, no instabilities ////antijinx\\\. My meniscus in my left knee is another story...
Whatever course you choose I wish you well and a speedy recovey
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Thanks agin for all the input, and to TheFugitive:
I had my Left Knee done by Dr Ferrari ar UMASS in 1994! Patellar Autograft.
HUGE THANK YOU for responding. Knowing that Dr. Ferrari is doing Allograft 13 years ago and you are going strong gives me huge confidence.
Small fucking world. :cool: Dr Ferrari said at the time he was involved in some pioneering work on the ACL allograft. If I remember correctly he said he strings the allograft tighter than an autograft because the allograft stretches or loosens more. I had very little ROM post op but it came back quick with PT. Are you still in Mass? Not sure if Dr. Ferrari is still in business since I am Utarded now but it might be worth a shot to look him up?Quote:
Originally Posted by meatball66
Good luck meatball, keep us posted.
Dr. Ferrari's son does the same work in Denver.
A name like that sells knee jobs...
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In the end, the fillowing is what swayed me. We today know to test for hep a, b, c aids etc. However we can't test for what we don't know exists such as hep d,e,f and so on. If you were having this done in the early 80's and went allograph, chance would exist that the doner could have had aids and the system didn't know to test for it. Autograph you are 1000% safe. Recovery, yes, more painfull, 5% hamstring power loss worth it for the piece of mind of never having to worry about the unknown. Another note, the donner could be anywhere from a teenager to an 80 year old. I know I didn't want 80 year old body parts in my 30 year old body. Autograph is the way to go unless you have used both patelar tendones and hamsttings in your 4 previous surgeries; need to make the Olympic's 4 months post surgery; or are an NFL linebacker who can't afford to lose hamstring strength.
MR, I agree that those are worth considering. I'll definitely be asking about the age of the doner, I think there is some control there. The worries about the unknown.....yeah, I guess. I have a 2nd opinion with another doc next week. Will keep you posted on the decision.
I would not hesitate to get a few opinions. I had a hamstring reconstruct 5 1/2 weeks ago from a Surgeon with 10+ years experience and claimed to have done over 400 acl procedures. I felt comfortable somewhat before surgery with the decision.
In the beginning he suggested hamstring autograft. I felt comfortable with his decision. 2 weeks later pre op, he suggested we do allograft!! I was like WTF? Why did it change? I am 39 and a medium duty athlete, but work heavy construction and lots of packing heavy materials on the job.
Personally, I think he forgot he told me autograft, so when questioned, he exclaimed I could do either, but that the allograft would heal quicker and be a faster procedure along with being plenty strong. I was concerned with long term failure, using my own stuff rather than a possibly infected person or the slim chance of a possibly weak or already damaged tendon. How would one know? He said he looks at them and if it was "orange or yellow" he could pick another one.
I opted for the hamstring at the last minute before surgery. Went under general anesthesia, and woke up a few hours later. Came out of recovery and that's when the pain set in.
She (the nurse) had me get up and use the restroom, then I was released to go home. The pain was brutal and only got worse. The doc said it would subside after 48 hrs.... BS!! 48 hrs later I was headed to the ER With massive swelling and brutal pain in the calf. My ankle was swollen to 13 1/2". (Other ankle was 9 1/2") I was taking warfarin/Lovenox for a previous blood clot in the calf.
He blamed the pain on the clots and prescribed dalaudid and percocet which I alternated the two and was taking 12 of each every day!! I am not a pill person so my tolerance was not built up. The pain was excruciating for the next 2 weeks!! The 25 pills a day was barely helping. And my calf was swollen seriously and hard as a rock.
It has been 5 1/2 weeks now post op. I am still on crutches and trying to get off the pills. Taking 6 or so a day now but still brutal. The knee I have been constantly elevating since the beginning and ice. He can't explain why it has taken so long to heal, as well as my therapist. I was injected with a steroid shot a few days ago as he said that would "jump start" things. It has done nothing. Pain is still 8-10 and I don't have the feeling I will be off crutches anytime soon. Mind you, this was ONLY an acl reconstruct. Everything else was supposedly ok.
Maybe I am just unlucky, but I sure wish I would have gotten more opinions. Just my 2 cents. Good luck.
Sharky74
Sorry to hear of your ordeal, really nothing like what I went through 20 years ago with Patellar Tendon Autograft. I have a 2nd opinion tomorrow, but I expect he will also push the Allograft. I'm expecting a relatively low-pain recovery and back at work quickly, albeit on crutches.
I thought my autograph healed fast enough. When I asked my surgeon what the chances of contracting undetected aids or hep c on an allograph were, he flat out said 1 in 25,000. I said those odds weren't good enough for me.Quote:
Originally Posted by M_R
Got my 2nd opinion today. He backed up the 1st Doc (different practices, not related). Said he does allograft, risk of infection / disease is exceedingly low now, more like 1:1,000,000.
Both Docs felt that the Allograft healing is fast but you have to be super concervative on the rehab in order to not stretch it out. Bike trainer in a few weeks, light jogging in 4 months.
Regardless of what graft, the graft only acts as a lattice; your body replaces all the cells with its own over time. It revascularizes and the new cells are actually ligament cells replacing tendon cells. Over time, the cadaver cells are gone, and you are all you again.
I'm doing the Allograft on April 14.
Good luck!Quote:
Originally Posted by meatball66
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http://www.sportsortho.co.uk/left-na...l-graft-choice
I think it would be allo for me if the time came
Meetball,
Good luck with the surgery.
As for what Sharky experienced, although I'm not a doctor i believe this had little to do with Allo vs. Auto. as I had a similar experience granted it went away in about 3 weeks.
I had the same thing happen with my Autograph, but here is why. Both Allo or auto procedures require the surgeon to cut through the synovial membrane that surrounds the knee joint ( The type of membrane that lines the knee joint is the synovial membrane. This type of membrane allows the fluid that it secretes to lubricate the joint. synovial joints are extremely important for joint health.) . What was explained to me was that this membrane is almost like a balloon that encloses your entire lower leg skeletal system. What my doc did not know during surgery was that I has a bakers cyst behind my knee. The cyst was ruptured during surgery and or after surgery and the liquid made its was into that membrane (balloon) and through gravity worked its way to my ankle! To emerg I went, calf and ankle black and blue less than a week post surgery and swelling and fucking hurting like crazy. Fear was of thrombosis (blood clot in the leg) so they put me on blood thinners as a precaution untill it was figured out what happened.
This swelling and the added pain had nothing to do with alllo vs auto choice, but do be aware that whatever your choice it , the possibility of complications is always present.
As for the Auto pain. You get a nerve shot of painkiller in your leg that last for 2 days, so no pain initially, but then you do feel the discomfort kick into the hamstring during the first couple of weeks. Nothing like the ankle swelling. The hamstring healed fine and was ready at the same time as the knee and never bothered me. Only at extreme exertion would i feel the 5% loose in the form of tightness where the graft was taken ie: on the third hour of an aggressive group ride attacking a big climb i would feel it, but the first two hours were always fine. and today 10 year later I never feel it and the knee is rock solid, except for the 90% missing meniscus but that's another story.
As for odds of infection, I agree they are low for what is known, but the unknown is just that, unknown, and I guess it depends what your family looks like. Me I've got 2 young kids and even 1 :1,000,000 is too big of a risk for me and my family.
Sharky hope everything goes well and your knee heal up to 100% of what it was before your injury, just a heads up that in my experience, even though you might be back to sports in less than a year it takes about 2 full years to get all the kinks and nerve damage and bone growth and revascularization out of the way to get to that 100%
Quote:
Originally Posted by Sharky74
Thanks for the notes MR. Will give an update next week!
Had it done today. Glad to be counting up towards recovery as opposed to counting down to surgery day. I guess things are really different than they were 20 years ago.
- leg immobile due to the allograft. When I had the autograft, we were bending immediately
- do driving for two weeks, This is a surprise and a big inconvenience
- 6 weeks on crutches and in brace
- 3 months of PT 1-2 times per week. I did none 20 years back.
Good luck with the recovery! It's rough, but it will be over before you know it. For me the first week was the worst.
I had an allograft 18 months ago for 3 reasons: faster healing (so I could get back to work at least, but not sports), no chance of hamstring tightness in the future (affects some people who have the hammy grafts), and no front-of-knee-pain when kneeling (affects nearly everyone who has patellar grafts for years afterwards, and I'm a carpenter). I have no regrets, and would do it the same way again.
I was also surprised by the immobilization. I wasn't expecting it, but apparently my meniscus was pretty trashed too, so they actually repaired it, and that's why I had to be even more careful than usual.
Ride road bikes as soon as they'll let you, and ride them a lot! FWIW, I did 2 sessions of PT total--the rest was on my own. Insurance wouldn't pay for it, and the PT people basically said "Just ride your bike and keep doing what you're doing, because you're way ahead anyway." In 6 weeks or so get a BOSU ball and do tons of 1-leg squats on it: I think it's about the best thing you can do.
Climberevan
Thanks for the advise. I did as much road riding on weekends and on the trainer weekdays leading up to the surgery. I plan on a lot of road riding as soon as possible. I agree with you regarding the PT, I'll want to take it easy and not push too quickly, that is the downfall of the allograft, but I'm sure I'll be on my own after a couple PT sessions.
Twenty years sure makes a difference because I was miserable with pain the first 14 days, I don't remember being such a wimp when I had the patellar autograft procedure 20 years back. Getting much better now. I can actually concentrate and get work done. PT going well, riding the bike on day 15.