ACL blowers--which reconstruction?

[huckasoreass]

I know a ton of people who have had ACL reconstruction, but the more input the better. Of those who have had surgery in the past 5 years, what's your success with hamstring vs. patellar tendon vs. cadaver? There are so many conflicting stories, I may as well be made more indecisive.

The doctor has encouraged me to go with hamstring. He claims the cadaver is less painful and has a quicker general recovery, but he wouldn't be able to give a full go-ahead for 8 months as opposed to 6 with the hamstring. That puts me in mid-February. Not ideal. Then there's the patella tendon, but he said for people over 35 (I'm in that bracket) who do what we do, sometimes they get under there and find the tendon beat up. So that may not work. But then I hear the hamstring graft works great despite more pain, but the real problem there is that your hamstring can be messed up for a year+.

I just want to get fixed and good to go by December/early Jan. I don't want to watch from the sidelines. Any advice would be appreciated.

[K-Stormchaser]

Im 6 weeks post op on my acl repair - cadaver. Played golf today for the first time. No knee pain, walking fine, strong muscles.

[basom]

i went with the PT graft, however i was 26 at the time. i'm happy and the knee feels great two years out. i'm pretty sure my doctor would have also advised me to get a hamstring graft had i been ten years older.

best of luck with your surgery.

edit: i was cut in late may and was back on skis in early december

[frozenwater]

I went hamstring and it really isn't to painful. I am 3 months out and longboarding, running, hiking, etc with no real problems. I expect to be skiing this fall without any real problems.

I went to the best guy I could afford. Make sure your doc does at least 10 hamstring/acl a week - otherwise find a different doc.

[Tyrone Shoelaces]

Huck --

I went hamstring route as well.

Had surgery on Nov 16th, 2004 -> Was back on snow (with orders to keep it mellow until I hit 6 months) in April, 2005 (4.5 months).

It was 4.5 months of intense rehab (PT visit 2 - 3x a week depending on my schedule), and then working super hard on my own killing it on the road bike and doing lots of leg-specific pilates exercices.

At 6 months post-op I was playing indoor and outdoor soccer back on my old teams.

Contined to cycle like crazy over the summer with the goal of knee being stronger coming into this winter than what it was pre-injury and it worked....had a damn good year and my knee is 100% and I think stronger than pre-injury for sure...so it can be blessing in disguise!!!

One issue I had with the hamstring injury, is that for a long time my op hammy was SUPER tight..not everyone experiences it as bad as I did....but I had to get a ton of massage work done on it as well so that my range of motion in my knee could progress on schedule.

Best of luck...keep asking questions...tons of experience/help/support here as you know.

Dr. Marder at UC Davis Medical in Sacramento was/is my doc...He's the Sac Kings ortho....I'd highly recommend him...mebee Oldtimer knows him???? Eric Heiden (yes the speed skater Eric Heiden) also practices in Marder's office and I know lots of my soccer player friends who have had great experiences with him as well.

Oh and I went hamstring mainly because Marder recommended it for me....thought it would be the best for me based on my goals, age (29 at the time, 30 now), etc.

[fez]

i had patellar, went with what the doctor recommended. im about two months post op and doing pretty well. still have some pain walking down stairs and kneeling is a no go for now. other than that, getting stronger, working hard and looking forward to next season.

[stump832]

I just had a hamstring graft done - 4 weeks postop just about. No complaints - rehab is coming along, and gaining strength slowly but steadily. The hammy is definitely sore though, thats for sure.

[rideit]

I was hamstrung...by Rork in JH. Best I could FIND, let alone (not) afford!
I was 36 at the time, horrible ACl/MCL/PCL 'terrible three'. I was fortunate in having remarkably 'long' hamstrings, I have had a great (but very painful) recovery, and am 110% in that leg now. Apparently, I was too flexible, and the extra hamstring tissue they used 'tightened me up' just right. wierd, I know, but that was my experience....

[atomicboy]

I went the patella route 11 years ago. The rehab is longer and you get the nice scar but I have been through the ringer and that thing is stronger than shit. I have taken some nasty spills on the slopes and on the court and it just keeps on going. Age is a huge factor if you are younger than 30 I would go for the patella. I know two that have gone the hamy route only to later go with the patella after the hamy could not hold up. Regardless, rehab is the key and do not over do it after a few months. Take your time. Good Luck.

[Ville]

I had hamstrings craft done in last August. I was skiing slopes in November, offpiste in december. I propably was skiing little bit too early and too hard, my knee isn't the best right now. It snaps when I straighten my leg... Maybe they have to operate it again. Does anyone have had same problems?

[Kellie]

I went patellar (age 25 at the time) a year ago March and the graft feels super strong, but I still have knee pain when running or skiing a long day at the resort (b/c is just fine . . .). If I did it over again, I'm not sure what I'd do.

I'm surprised there haven't been more ringing in for cadaver.

[Dexter Rutecki]

Hey Huck,

I know we've had a few extensive threads on this in the past, and i've given a lot of my input so i'll try to find those, but i've had two patella grafts and couldn't be happier about the results. I had the first when i was 28, and the second at 31 (after 24 years skiing without major injury there was a rough stretch of three knee surgeries there). i've also spoken with a few other surgeons at Special Surgery and they all prefer the patella graft for people who seriously ski, but i get the impression that out west there's more backing for the hamstring.
i also checked up on studies and found that there had been some concern about hammy grafts 'loosening' over the years or becoming weak, although this no longer seems to be the concern it used to be (they now double up on the hamstring graft which seems to have helped).
The only downside to patella is it ruins your ability to kneel, or at least it did for me. But that's not something i really enjoyed doing before anyway, or have to do. Also it takes more than six months for deep knee bends to feel normal in the front of the knee, so even after you're back on snow the knee still feels a bit weird.
But the results down the road are excellent. For skiing and basically all other sports my knee feels as good or better than it did before. i think recovery is a bit longer and harder, but end results seem worth it.
Good luck, i'll check for the old threads.

[SnowTigress]

Cadaver +++ Go dead body parts!!
Very little post-op pain, quick recovery, suuuuper strong now. My other non-surgeried knee hurts way more than the new one when I run.
I do have these strange dreams and weird impulses now though...?

[Primo]

I went cadavar.
surgery last season. operated on october skiing January with doctor and PT
approval.
Dr.Gottlieb one of the best in the world IMO. Sure as hell has practice at it.

[Lane Meyer]

I'm no doctor, but I say invite Alkasquawlik over for dinner, slip him some rophynol, then get your brother to carve him up and transplant his whole knee into yours. Then you'll be good to go.

[atomicboy]

I had hamstrings craft done in last August. I was skiing slopes in November, offpiste in december. I propably was skiing little bit too early and too hard, my knee isn't the best right now. It snaps when I straighten my leg... Maybe they have to operate it again. Does anyone have had same problems?

I have something similar on my good knee and the operated one. I would get it checked out. If it sounds like a dry twig cracking and/or a pop it could just be a meniscus issue ie tear. It is a pretty easy quick fix in out patient. Walking after a day or two and back to normal after a couple of weeks. I have surgery slated for mid July to get mine fixed

[upallnight]

It is a pretty easy quick fix in out patient. Walking after a day or two and back to normal after a couple of weeks. I have surgery slated for mid July to get mine fixed

Kinda beg to differ on this one. If you're talking menisectomy (removal), that will have you on your feet faster, but it is the very first step in the end of the knee.

Meniscus repair (had one 6 weeks ago) is supposedly a 100% recovery, but it is relatively more rare to have enough good tissue to salvage and attempt a repair. That said, the recovery depends on the extent of the tear and the anterior/posterior location of the tear. (Posterior allows you to progress faster.)

I do hope you're on your feet ASAP... In my case, I'm 6 weeks out, still dealing with crutches a bit, and am not allowed to bear weight on my leg if it is bent more than 45 degrees, although I have been getting my range of motion back. It's probably 5-6 months before I can climb again.

(My surgeon is a US Ski Team doc, so I didn't just go to some hack.)

Anyhoo.... I truly hope folks have minor issues (many do and some are truly incidental)...but I hope this can make some people ask more questions of their doctor (pre-op) and just be aware of all that can be done. I find, in general, that many doctors give highly optimistic estimates of the recovery. The real deal is sometimes different (and often longer).

[maddog]

I had the hamstring graft about 5 years ago (age 40) and the knee is real good now but the hamstring is not as strong or loose as I would like. If I had it to do again, I'd go with the cadaver, in order to maintain a strong hamstring. As far as recovery is concerned, it's better to sit out a season and ski for the rest of your life, than to ski next season and never again. Incidently, I don't have an acl in my right knee. Tore it in 1978 and didn't miss a season until 5 years ago when I got the left one repaired. Pain is part of the fun of growing older...and life just gets more and more fun!

[Arty50]

Huck --

I went hamstring route as well.

I would listen to this ^ guy. He's the poster boy for the hamstring graft.

[Chainsaw_Willie]

Hamstring graft in right knee back in February '96. I was 28 at the time. There was a lot of post-op pain for about 5 days or so but once the pain abated and I regained some flexibility I strengthened up quick. Spent a week hiking the Alpine Lakes High Route (lots of vertical gain and loss in one day) in August with no problems and skiing the next season. I do wear a knee brace when i ski but don't really know how necessary it is. Just know that I don't ever want to do that again...

[NEngineer]

Cadaver. 6 weeks ago. Very little pain post-op. Been riding the stationary bike for the last 3 weeks and rode outdoors for the first time today. I can walk up and down stairs with no pain at all. It's quiet amazing.

I did a bunch of PT before the surgery. The stronger you are going in the better it is and thats true for any type of ACL reconstruction.

Good Luck!

[atomicboy]

[QUOTE=upallnight]Kinda beg to differ on this one. If you're talking menisectomy (removal), that will have you on your feet faster, but it is the very first step in the end of the knee.

Meniscus repair (had one 6 weeks ago) is supposedly a 100% recovery, but it is relatively more rare to have enough good tissue to salvage and attempt a repair. That said, the recovery depends on the extent of the tear and the anterior/posterior location of the tear. (Posterior allows you to progress faster.)[QUOTE]

Thanks for the clarification.. I was talking posterior repair not removal. I have a minor tear that I am getting repaired along with a Baker's Cyst.

[huckasoreass]

Thanks everyone. Just as I figured, not a ton of clarification. I was hoping to get a blaring GO WITH CADAVER but that's not the case. Has anyone had problems with the cadaver? The other two methods seem to have their cons, but other than taking a little longer for full strength, the cadaver seems a good way to go. As long as I can have a little patience next winter...

[romanandrey]

My father does these and he's very good. He's also an expert skier, and focuses on treating athletes, college, pro, and amateur.

He doesn't like cadaver grafts. Convinced there's a significant risk of persistent, low-grade inflamation from tissue rejection issues.

He used to do Pateller grafts, and many pro athletes, esp football players, prefer this because they believe it produces the tightest joints. But my dad has switched to doing hamstring grafts, for the most part, because he says techniques have improved to the point where you get an equivalent result.

You should be aware that the skill of the surgeon (unfortunately) plays an usually high role in this operation. The best doctors get outstanding results, with low incidence of redos.

On the cutting edge, a very, very few docs are now trying to replicate the dual bundles of the ACL ligament, rather than just replacing it with a single graft. My dad, being old fashioned, thinks this will only up the incidence of poor results, as it's a more complicated proceedure. My brother, who is just finishing a sports med specialty program, thinks the new proceedure will eventually become the standard, because it replicates natural anatomy, with (theoretically) a lower risk of arthritis.

Good luck!

[truth]

I went PT graft and all is well. It's probably the toughest rehab though. I'd hold off on cadaver until it's your only option.