ACL blowers--which reconstruction?

[DanKo]

I had them take the PT from the knee I did NOT injure. Contralateral graft versus isolateral...wondering what folks opinions are on that option. If I had it to do over again, I'd get the PT out of the same knee I hurt...

Blew the ACL in April 2003, got PT surgery on it memorial day weekend 2003. 5 days in a passive motion machine. I never used crutches and they had me on a stationary bike after day 5. I took my rehab SUPER seriously. It took ~ 3 months before I could bend the knee to touch my foot to my ass or to sit indian style. 3 years later, I *still* find it uncomfortable to kneel on a hard surface and I can feel occasional clicking when I completely lock my knee, but that is really it.

I had the surgery in late May and was making turns no problem in mid-November. But, like I said, I took my rehab SUPER seriously.

I have heard that the hamstring graft is an outdated procedure.

[Dexter Rutecki]

Contralateral graft? That sounds crazy. I thought that was only done when there was some other problem that prevented taking the graft from the same knee.

i don't think hamstring is outdated, if anything it's become more common since they improved it. But I've always heard the patella tendon graft referred to as the 'gold standard' of ACL repair.

[maddog]

My doc told me he could use an achilles tendon from a cadaver for a super strong acl, but recommended the hamstring graft 'cause he's had the most success with that. I think recovery is more about how strong you are going in, and how hard you work coming out. A high tolerance to pain is also helpful

[altagirl]

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.)

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.

I had a posterior buckethandle medial meniscus repair like 12 weeks ago. 4-6 weeks non weight bearing (I got the go-ahead for "only" 4 weeks and a little bit of weightbearing in the 3rd and 4th week). But it takes an eternity compared to a partial menisectomy (which is what I had on the other knee a few years ago). Unless you have an incredibly small tear in a really convenient place, I guess. 99% of meniscus repairs involve weeks of non-weight bearing to allow the repair to heal.

And back on topic - I had a hamstring graft on my left knee and an allograft (patellar) on my right. The allograft was definitely easier. Hell, in some ways the allograft was easier than the meniscus repair, since I could walk on it right away. Luckily the meniscus repair didn't cause enough swelling to cause any loss of ROM, so not having to worry about that at all made this easier - just the PITA of the crutches and atrophy from not walking for 4 weeks.

[upallnight]

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.

Posterior meniscus repair should be easier to deal with than anterior. You can progress to weight-bearing faster.

As of day 1, I was able to toe-touch with crutches.
@ 2 weeks, I could go to 50% weight-bearing.
@ 4 weeks, I was able to go full-weight bearing and get off crutches as soon as possible/comfortable. I took my first steps w/o crutches
@ 5 weeks, my doc told my therapist that I should not be weight-bearing with the knee bent more than 45*. (Umm...well, I'd been doing this under the guidance of my PT for a week....wish he had told us sooner and I am worried I either delayed healing or caused the repair to be more likely to fail.)
@ 6-7 weeks (now), I'm back to crutches and light weight-bearing. I hope it's a temporary setback.

Anyway, mine was a more severe tear closer to the front. I post this to show you what I faced -- and to let you realize that you should do *much* better than this.

If I had a posterior tear, I think I'd be full-weight bearing to 90* by now.

[upallnight]

I had a posterior buckethandle medial meniscus repair like 12 weeks ago. 4-6 weeks non weight bearing (I got the go-ahead for "only" 4 weeks and a little bit of weightbearing in the 3rd and 4th week). But it takes an eternity compared to a partial menisectomy (which is what I had on the other knee a few years ago). Unless you have an incredibly small tear in a really convenient place, I guess. 99% of meniscus repairs involve weeks of non-weight bearing to allow the repair to heal.

AG:
@ 4 weeks, were you able to bear weight w/o restriction (i.e., > 45* bend)? I'm at 6.5 and still under that restriction...but I'm worried that I may have screwed things up b/c my doc did not tell my PT that was a restriction, so I'd been doing partial weight-bearing w/ bending up to 60*+ for a little while per the PT's instrux. Hope that didn't weaken the repair and cause it to be more likely to fail & then require removal (=this rehab + pain for nothing).

I'm told some folks walk out of surgery w/ the menisectomy.

[Jim S]

Meniscal and ACL injuries, while associated, are apples and oranges regarding treatment and recovery.

Huckasoreass, see my PM.

I wanted the stongest ACL repair possible regardless of the duration of recovery: autograft.
I had mine about age 37...six years ago. PT was a bitch but I'm glad I did it. Occasionally I get tendonitis at the donor patella tendon site but a KNEED-IT brace helps a lot.

[Long duc dong]

I went with the patella graft. Had the surgery about 2 years ago and it is doing great. PT was not much fun, but it really was not that bad. Hope not to do it again though.

[altagirl]

AG:
@ 4 weeks, were you able to bear weight w/o restriction (i.e., > 45* bend)? I'm at 6.5 and still under that restriction...but I'm worried that I may have screwed things up b/c my doc did not tell my PT that was a restriction, so I'd been doing partial weight-bearing w/ bending up to 60*+ for a little while per the PT's instrux. Hope that didn't weaken the repair and cause it to be more likely to fail & then require removal (=this rehab + pain for nothing).

I'm told some folks walk out of surgery w/ the menisectomy.

Yeah - once I was at 4 weeks, there were no restrictions on weight bearing other than while doing leg presses/single leg wall sits. There I'm still not supposed to go quite to 90 degrees. Well, and I'm not supposed to do anything that could involve a big fall. (Therefore I rode Amasa Back on Sunday with no armor, since that would mean I'm taking it easy, right?)

And yes, with my partial menisectomy, I couldn't walk into the hospital, but I walked out. I was back skiing and biking at 4-5 weeks.

My only real problem with this meniscus repair has been with my pes anserine - which I'm not even sure is related to the whole meniscus thing. But about 4 weeks ago, I was sitting at my desk, swiveled around to answer the phone and holy shit - YOW - massive pain on my shin right below the patella on the medial side. It swelled up right next to my old ACL scar - like a silver dollar sized spot. Went in to PT like an hour later just to ask what the hell it was and they iced it and said it's where part of your hamstring attaches. It felt like it caught on something and ground across it. A couple days later it was fine, but I've irritated it about once a week since. Always doing some stupid shit like sitting at my desk. I can mountain bike and exercise a couple hours a day and feel 100%, go back to my desk and hurt myself again. It's really pissing me off.

The only thing I can think of is that my hamstring is just weak. Because it was a posterior repair, they made me hold off on any hamstring work for a few weeks and maybe it's still catching up? I went and saw my surgeon and he said it's possibly some scar tissue or part of the screw from my ACL about 20 months ago sticking out of the bone there, but there's nothing on the xray. His only solution was to suck it up or he'll do another surgery to scrape the bone/scar tissue down and I can be back on crutches again. No thanks.

[Jim S]

Always doing some stupid shit like sitting at my desk. I can mountain bike and exercise a couple hours a day and feel 100%, go back to my desk and hurt myself again. It's really pissing me off.

I should PM you but I'll post here. Let's make a deal:

I write you a doctor's note excusing you from work.
You give me a place to crash if I visit UT to ski.

[cololi]

I have had both ACL's done, both were hamstring grafts. Returned to full activity at 6 months with both. No problems since (knock on wood). First ACL was in 99 (at age 25), second in 01 (at age 27). Surgeon was Hugh West in SLC.

[lhs]

another vote for hamstring -

had mine done, gosh i guess 4 years ago now. cut in march, skiing in November. Recovery was a little slower than w/ patellar tendon graft i think, but since about a year out i've had absolutely zero knee pain or problems - if i didn't have the scar i'd probably forget which knee it was. so i'm a happy customer.
the doc (busconi in MA for all you east coasters) does dozens of ACLs a week pretty much, and at the time (2002) said that, yes the patellar tendon was the 'gold standard' but that he was doing more and more hamstrings every day, thought the recovery was more complete (no knee pain/tendonitis), and expected to be doing predominantly hamstrings in a few years (ie, right now).
so, yeah. good luck.

[ski_adk]

I'm 3 years post-op on a hamstring auto graft. Went into surgery in March and was playing volleyball in October and back on-slope in November. I took the rehab fairly seriously and it's been doing great for me. This past season was the best in my life, and it was the first post-op season without my brace (I wore that f*cker out so bad...). I get a little soreness which seems to coincide with big low pressure systems and I experience an occasional knuckle-cracking sound when I move it just the right way, but other than that, no real problems. Cycling helps a lot if it's feeling a little loose or sore. But, all-in-all, my rebuilt knee is good and I've had no problems with the hammy being too tight or any of that. First 2 weeks post-op were sucky b/c of swelling, but a couple hydrocodones and a few beers and I'd hardly notice the pain. Strangely, the whole injury/rehab thing was a really good experience for me.

[altagirl]

I should PM you but I'll post here. Let's make a deal:

I write you a doctor's note excusing you from work.
You give me a place to crash if I visit UT to ski.

That's what I was thinking. Shouldn't I get disability or something for that?

[Theodore]

I had a patellar graft. Kneeling still isn't comfortable(insert random ghey joke here). That scar is right in the way. Hammy graft was out for me since I tore it off with my injury. I heard in PT that they are the better way to go and becoming more common every day. Can't help you on recovery time, my knee was fucked and differed from an ACL only injury by a LOT.

[Mtn Man]

I'm 34 right now and had Patellar graft done May 11, 2005, was on the snow hiking for turns Oct 28th (less than 6 months). I had extensive damage to the knee (hyperextension, total ACL rupture, cracked tibia plateau, strained MCL and hamstrings, lots of meniscus damage, etc) so the knee isn't quite 100% right now. But I believe the ACL is doing quite well, infact, got day 60 in yesterday with a little hiking involved.

As stated by others, kneeling is hard right now. But I'm not a plumber or hooker, so I should be ok....

Good luck!

B)

[altagirl]

I forgot to mention my timelines:

Back skiing at 7 months with the hamstring ACL
Back skiing at 5.5 months with the allograft ACL

Though the hamstring one also involved a meniscus repair, which meant I was on crutches for 6 weeks, and that blew. Not to be confused with the current meniscus repair which is on the other knee and didn't involve any ligament damage.