My Successful ACL Surgery

[kick]

I completely tore my right ACL playing "touch" football on Halloween weekend 10.30.05. I heard the infamous "pop" and felt searing pain and went down. Hospital x-rays were negative for any break and two weeks later I was FINALLY able to get an MRI. The results revealed the complete tear. A friend had suggested a well-known orthopaedic physician at the time but he was booked solid so I scheduled with another doctor in the group. This doctor went into "some" detail (not enough) regarding the MRI. He discussed the pros and cons of surgery, auto versus allograft, as well as thoughts on natural rehab. He said there was no rush to fix it and he wrote a script for PT and I began my efforts to rehab without surgery. I have a gym membership and am an avid proponent of weight lifting and cardio. I was able to start leg strength training a few weeks after the injury and each week progressively gained muscle and strength. I also did extensive reading on ACL injuries, non surgical rehab and reconstructive surgery. During the entire time of rehab I was not able to bend my leg back and it felt like it was being impeded by something. PT suggested that it was still inflammation impeding my range of motion. I saw the first doctor two weeks later after the initial appointment. PT had reported to him that I was in a brace now and pushing to get back to being more active. At that time he started nudging me more towards having the surgery and that the PT department was concerned that I would do further damage. Again he said no rush and that he wanted to see me again in six weeks.

At that time I decided to seek a second opinion and called to schedule an appointment with my original choice of physician. As luck would have it he had a cancellation and an appointment opened up for me. What a difference it makes when you seek a second opinion! Tom spent a good 45 minutes with me reviewing everything. In reviewing the MRI he pointed out the obvious ACL tear, but also showed where I had some bone micro fractures, which explained the still tender left side of the knee. He then showed me a very obvious meniscus (cartilage) tear. He likened it to a hangnail and said that the tear was the primary culprit of my inability to bend my leg all the way back. Gee, now why didn’t the first doctor catch that? He explained how he performed ACL surgery and I was already sold on proceeding after that. He went on to explain that I needed to have this done and that I ran the risk of serious damage if I did not. Take that with a grain of salt if you will but for me, I knew my knee was not at all stable AND, I wanted to have the best use of it and the least amount of probable further damage.

The surgery was on Monday 2/6/06 and I was there at 6 a.m. Blood was drawn for testing. The knee area was shaved. I was given a glucose IV for some dehydration. I was wheeled into the O.R. around 8 a.m. The glucose IV was replaced with the sedative IV. They added some anti-nausea to the mix for good measure. I was given two nerve blocks, femoral and sciatic in my right groin, which completely numbed my leg. I was pleased that the doctor told me that I would only have local anesthesia and just a “twilight sleep” IV. I don’t deal well with general anesthesia. The sedative kicked in and I was lights out very quickly.
For the surgery, the knee was "scoped" in two places for the doc to take a peek to see the damage. He did an approximate 15% meniscectomy (removal) of the damaged cartilage. An inch long incision was made on the left side of my lower knee and the doctor drilled a tunnel from the tibia and up into the femur for which to place the new ligament. He used a cadaver ligament (allograft), which was affixed to both bones with screws. I woke up in a recovery room and was actually feeling great. My leg was numb and in a brace. I was home by 11 a.m.

It’s now been a month since the surgery and I am walking fairly well and have minimal swelling and scarring. I was back at the gym starting beginning week two and started on the exercise bike at the end of that week. I continue with PT once a week and supplement that with exercises at home and working out at the gym. Both my doctor and PT told me that the ligament is at its weakest at around week 6 so I still am extremely careful not to pivot or make any lateral movements while my foot is planted.
I think there are several reasons as to why my surgery and subsequent rehab and recovery have gone this well. One is my surgeon. Two is the length of time I took between injury and surgery. Three is the fact that I had a cadaver graft and not my own patellar or any other auto-graft. It made for a quicker recovery. Four is the Polar Ice Kit that I purchased. I kept my knee constantly iced with this and slept with it on for two weeks solid. I highly recommend it.

PICTURES
All but the last pictures were taken with saline flooding the knee joint. The first set of pictures is of healthy cartilage. Set 2 is where the surgeon probed and found the torn cartilage or meniscus and removed approximately 15% of the cartilage. Set 3 has a picture of the torn ACL, which is just lying there in a big blob. Set 3 also includes a picture of the cadaver ACL (allograft). Set 4 is a picture of the new ACL in my knee without the saline.

The other pictures are X-rays of the knee showing the setscrews, which hold the new ACL in place. If you look carefully you can see the drill path, which runs through both the femur and tibia.

[Skibumtress]

Kick, thanks for your report. I'm going through a similar situation (http://www.tetongravity.com/forums/s...ad.php?t=48616) so this is very helpful.
Another person I know is going for the allograft but why did you choose the allograft? Less invasive surgery? Less recuperation time? My concern about the allograft is the body rejecting it and that the graft doesn't last as long. Why not the hammy graft?

[Endlessseason]

I'm also curious about the choice.
My doc (the same doc who did Tiger Woods) told me that because they have to microwave (irradiate) cadaver grafts for bacteria it weakens (partially cooks) the tissue. He said there is some thought out there that this may affect the longevity of the graft.
His opinion was that, even though recovery is slower and it hurts more, he now only recommends hamstrings. He doesn't recommend patellar's because the strength difference between auto and patellar grafts is less than 5% and a significant percentage of patellar graftees are never able to kneel on the repaired knee again.
That was two and a half years ago. What are the top docs saying now?

Anyone?

[kick]

I had the same concerns. My best friend had his left ACL replaced in '96. Patellar tendon graft, passive motion machine, over night stay at the hospital, 6 month recovery. A great deal has changed since then.

I chose the cadaver graft for a quicker recovery time. It is less invasive and I wanted one surgery, not two. There are a TON of opinions out there and each doctor is going to have his or her own preference. I guess it boils down to do you trust your doctor. I did. He laid out the pros and cons. Without having the actual stats and evidence in front of me I had to trust that what he was telling me was true. He does 800 ops a year, 200+ purely ACL. He stopped using patellar or other auto grafts about 7 years ago and said that (again, according to him) the evidence showed no difference in strength or durability.

An allograft is not like an organ. Your body doesn't reject it. Your body has to do the same nerve and tissue regeneration around the allograft as would your own autograft. Is there a risk of infection or disease? Yes, but again, you have to trust the facility and organization as a whole. That said, the infection risk is extremely small. There are risks of infection with any surgery, auto or allograft.

I'm not a professional athlete. If I were I might make another choice but I don't know really. My PT does ski patrol on a local mountain and has had his done twice. Both times autografts, just because he didn't like the idea of a cadaver body part. It's just a matter of preference. All I know is that my down time was minimal and recovery has been very speedy. Good luck all.

[Skibumtress]

Thanks Kick! Don't know what this second opinion Doc will have to say but good to learn personal experiences on the different methods.
By the way, are you on the WC or EC?
I have another doctor in mind but doesn't hurt to get other opinions on other Docs.

[orange]

Hey man, I went throught the same thing....I just did it skiing...

You're pictures look almost identical to the ones my Doc showed me...I'm 4 weeks and 2 days out.....Good luck with everything.

[kick]

Very cool! Good luck 2 u 2. I'm on the EC. PA. Lehigh Valley, north of Philly.

[Skibumtress]

I'm on the EC. PA. Lehigh Valley, north of Philly.

Oh well, I'm in Northern NJ. Do have a few other Docs on my list tho.

[fez]

this is quite the club we've got going here. i had my patellar tendon graft acl repair done just about 24 hours ago. so far feeling pretty good, though it could just be the oxycodone talking.

i also realized that if you have to have your acl repaired, college bball championship weekend is not a bad time to do it.

good luck everyone who is recovering or about to go under the knife!

Anyone else want to join me in trying to recover and get strong enough to do a straightline adventures camp next winter? thats my goal.

[Skibumtress]

this is quite the club we've got going here. i had my patellar tendon graft acl repair done just about 24 hours ago. so far feeling pretty good, though it could just be the oxycodone talking.

Sure is quite the group Fez. I'll ask you the same, why the patellar graft? Looking at different experiences 'cause I'll be looking at ACL reconstruction in a month or so. Here's my thread (http://www.tetongravity.com/forums/s...d.php?t=48616).

Glad you're feel pretty good. I understand this is the most evasive of all the ACL reconstruction surgeries.

[fez]

went with patellar because its what my doc prefers. he claims it is the strongest of all the techniques because he is screwing bone to bone. actually he told me the patellar graft is stronger than the oem acl.
my doctor is john campbell, regarded as the best in bozeman. he does a couple hundred acls a year (4 yesterday alone), has done over 2000 total. is a US ski team doc and the ortho for the montana state football team. and used to be a ski bum (troller at alta). so with his rep and experience i decided to trust him on it.

[Skibumtress]

went with patellar because its what my doc prefers. he claims it is the strongest of all the techniques because he is screwing bone to bone. actually he told me the patellar graft is stronger than the oem acl.
my doctor is john campbell, regarded as the best in bozeman. he does a couple hundred acls a year (4 yesterday alone), has done over 2000 total. is a US ski team doc and the ortho for the montana state football team. and used to be a ski bum (troller at alta). so with his rep and experience i decided to trust him on it.

Yea, I'd trust a Doc with credentials like that too!
Good luck with your PT and road to recovery!

[WestCoastPDR]

Bummed trees and Kick.

Im flying home mon 3/12 for my 4 week update. I was living at the base of alta, dropped a cliff and fully ruptured the acl and mcl. Surgery was at Duke University. they where gonna take the hammy even went as far as making the cut into the hammy tendon to take it out. They ended up opening the fridge and getting a donor tissue instead of using my hammy. There was not enough tissue for them to use on me so they reconectted the hammy and sewed me up and finished the job using the donor tissue.

Now 4 weeks post opp. Last wknd 35" of blower out side my office. It was killing me seeing all the cats walking off the hill.

I have 130 degrees of flex stairs, walking, hyper extension with heel off the ground, balance on the injured leg are all going very well. Physical therapist say that ive been progressing faster than anyother patient they have seen. Actually walked in the woods the other day checking out damage from wind and snow back in october up at a friends house.

I hope all is well with every one and I hope that this info is an incentive for everyone to work hard at the PT because it will pay off.


Anyone down for chili in August?

[Wandrin*]

Sounds like I might be signing up for that chilli. I will be seeing an orthopedist Wednesday to determine what I did to my knee on Saturday.

Good luck everybody!

[Endlessseason]

Anyone down for chili in August?

"99 cent Chili at Wendy's until 2 AM. Year 'round. It's not just for winter anymore...."

[jenscats5]

Hey Kick! A friend referred me to your post & I joined simply to say Thank You for posting that up.....I'm having pretty much the exact same thing you've had done on 4/4 and had my pre-op Dr. visit today.....am feeling pretty nervous about it too - but not AS much now....

Thanks again!

[Skibumtress]

Hey Kick! A friend referred me to your post & I joined simply to say Thank You for posting that up.....I'm having pretty much the exact same thing you've had done on 4/4 and had my pre-op Dr. visit today.....am feeling pretty nervous about it too - but not AS much now....

Thanks again!

Welcome Jens, thought this would be a helpful thread to you. This "Gimp Central" has been the most helpful for me and stays on the topic..... not like ummm.... other boards we know.

[kick]

You're very welcome. I was pretty nervous as well, especially when "friends" would tell me about and I would read online about ACL horror stories. That's the whole reason why I posted. There are SUCCESS stories. Good Luck!!

[kick]

Just as a follow up, it's now week 5. Last Thursday my PT released me to do rehab on my own for a month. He said that I was about 3-4 weeks ahead of most at this point and that I can do most of this at the gym and at home. I'll go back mid April to start with plyometric and more advanced balance exercises.

[jenscats5]

You're very welcome. I was pretty nervous as well, especially when "friends" would tell me about and I would read online about ACL horror stories. That's the whole reason why I posted. There are SUCCESS stories. Good Luck!!

Kick: Still a little nervous over the "donor tissue" issue.... but I'll have to get over it somehow....dr. tells me it (in their experience) is 25% stronger than the hammy-graft.....

Keep up the updates so I can follow along....My pre- and post-op PT is being guided through a Univ. study group I'm in - so I don't know if I'll differ from you there or not...

Thanks again SB!!

[kick]

Just an update.

I'm at 10 weeks and still doing quite well. After a month off to train on my own i went back to PT last week. It was mostly all positive. The only negative was that he told me I was over doing it on the depth of motion on my leg exercises and was aggravating the knee cap a bit. Nothing major but he said tone it down and use less bend for a while. He gave me some jumping and side lateral step exercises to incorporate into my existing rehab routine. It's still very early in the process but I think I'll be back to my old self soon. However, If I ever play football, basketball, or ski again I will certainly wear the brace I got prior to sugery and even then, I'll take it easy. I really don't want to go through this again like some have! Good luck!

[cmvsm]

I'm about to go through an ACL replacement myself and your situation sounded very similar to mine. My doctor said, in this day and age, it is a "no brainer" to not go with the allograft due to the recovery time and similar characteristics of an autograft.

I guess its been over a year now for you. I'm sure you are back 100%, or at least hope you are. Any updates as to how the knee is working out? Any other tips on the surgery?

Thanks again for your post!

[drmork]

I'm about to go through an ACL replacement myself and your situation sounded very similar to mine. My doctor said, in this day and age, it is a "no brainer" to not go with the allograft due to the recovery time and similar characteristics of an autograft.

The number of reasons not to get an allograft is almost as massive as my own ego. With my successful technique, I can take just about any part of your body and make it work better than an allograft. Most of the younger surgeons never learned how to harvest a patellar tendon graft with one arm, while sipping from a quadruple can beer hat and fighting off mercenaries from the allograft industrial complex with the other arm. If you don't believe what I'm telling you about the international allograft conspiracy and you have a strong stomach, just google the story about the guy who woke up in a tub full of ice with “YOUR ACHILLES TENDON IS GONE” written in lipstick on the bathroom mirror.

[drmark]

Dear DrMork,
Cute.
I wish I had as much free time as you do.
Looking forward to seeing you at next year's AAOS
Best regards,
Mark Sanders

[kick]

Sorry for the delay in responding. I don't check in much these days. 18 months later and the knee is great. I've got no problems with the ligament. I have no clue who Dr. Mork is but he's clueless. Good luck!