ACL Repair- Part Deux (Comparing Allograft and Autograft Experiences)

[amitshow2001]

Guys,

I am going to the jury to help me make the final call after the judges have confused me so far. Re-wind 4 weeks ago - Fully tore my ACL on my left knee playing touch football....(yes, touch football) . My friends rushed me to ER after the pain was unbearable when I actually tore it. Our good friends at ER diagnosed it as MCL but I knew it was torn ACL and my orthopedic doctor confirmed it the next day when I visited him. I also partially damaged my lateral meniscus.

Status as of today --- have been doing PT and able to get around -2 extension and 100 flex ion. However, the issue is I still can't walk with a completely straight knee as there is substantial pain on the right side of my knee (opposite to MCL). Saw my doctor yesterday and he thinks that meniscus might be locking my knee to be completely straight. Visited another doctor today to get a 2nd opinion and got a contrasting opinion from my doc # 1. Below, is the short/brief description of the two doc's recommendations.

Doc # 1 -

- Should get a surgery right away as thinks going to PT won't help much as I still can't get my knee straight after 4 weeks.
- Highly recommends allograft as he believes it's less painful and recovery is faster.
- Since I play sports (football (which I might never play again) and tennis (which I would play as long as I could) for recreational purpose allograft is the correct option.
- Might require some fixing of my meniscus during the surgery.
- CPM machine not required after the surgery as results have not shown any advantages of it over the years.
- Outpatient

Doc # 2.
- Wait few more weeks to get the surgery done as he wants more ROM.
- Highly recommends reconstructing ACL with hamstring as he doesn't believe there is any difference in post-op recovery using hamstring vs. allograft. Believes hamstring option will build a much stronger ACL and chances of rupturing it again in the future is substantially low with the hamstring option.
- Will use CPM post operation.
- Will be on a brace for 6-8 weeks post op.
- Will stay overnight in the hospital.

Wow....I need to cut it short before I bore you guys to death. Long story short, I am totally confused on which option to go with. My brother went with hamstring option last year and he is still fighting with scar tissue issues on quad from where the hamstring was taken. The thread below is really helpful but it's little old and just wanted to see if any of you guys were in the same dilemma I am in and which option you selected and how is it going now. I am highly relying on my jury to make a decision for me.

Any responses would be greatly appreciated.

[doughboyshredder]

I know that in my case my recovery from allograft seems much quicker than some peoples recovery from hamstring graft. Family member had hammy and he's not at 100% yet, and it's almost a year. I had an allograft and I am almost at 100% after six months. Initial recovery seems to be faster also.

Downsides, afaik: allografts have a higher failure rate. Up to 25% according to some studies. Supposedly, this is mainly because the knee is feeling better much faster, so the patient takes higher risks before it's completely healed. Also, with an allograft the repaired knee is just as strong as it was before, whereas with a hammy, it's usually stronger than it was before.
hamstring grafts: longer recovery, additional surgery site, more pain.

After a lot of research, and visits with two docs, I felt that for me the allograft was the right decision. I am very pleased with my choice now. I am surprised that your doc #2 said that about recovery, because that's completely incorrect, as far as I can tell. The doc that I talked to that wanted to do a Hamstring graft said I probably wouldn't be able to snowboard this season, besides maybe some groomers towards the end of the year. The doc I went with says that I am going to be ready to snowboard next month, and will be able to fully charge by the end of December, maybe earlier. The recovery time is drastically different in my experience.

Another very important thing is which doc do you feel the most comfortable with?

fwiw, I had a minor tear of the MCL, minor miscus damage, and a completely shredded ACL. Surgery was 6 months and 1 week ago. I am now almost 100%. I am working out with P90X and riding the exercise bike daily. Back to normal activity levels completely. I feel like I could go snowboarding today if there was snow.

[Cedrik]

Highly recommends allograft as he believes it's less painful and recovery is faster.

Pain is individual and it takes as long or longer for an allo to heal internally. You do feel better faster, which as dbs said may be the reason for higher failure rate in young athletes.

Go with the doc who you think will do a better job.

The ACL Class of 2011 thread shows what a lot of us chose this year (mostly hammys, some patella auto and some allo). I'll add you to the list once you get cut and drilled.

I fully ruptured both ACL and MCL and got a hammy with the harvest from the opposite leg (which I really think helped with the quick and easy recovery). I'm at six months post-op, feel great, and am doing almost all activities I did before the surgery. Because of the MCL I was in a brace for 8 weeks, but for ACL only I thought you don't need a brace. Maybe the brace it so keep the meniscus safe. I went home right after the operation and didn't use a CPM. I'm very surprised that doc#1 wants to do surgery without you regaining full ROM. In pre-op PT there was a huge focus on ROM and that was the key indicator to get cleared for surgery.

You injured your left leg, so the right side of your left knee is the MCL. I think you tore the MCL, which they can easily repair while they're fixing the ACL. MRI's are notoriously vague about less obvious damage. Good luck!

[amitshow2001]

Guys,

Got done with my surgery yesterday with an allograft. As I write this e-mail, there is some moderate pain around my knees. Maybe it could be related to the fact that they had to trim nearly 50% of my lateral meniscus.

I guess I wanted to get a sense of the below questions and how you guys handled it?

- When do I start doing my exercises at home. My doc told me to wait a week to re-join PT but nothing specific about when can I start stretching my knee at home.

- What's the typical timeline on how long you use crutches after the surgery.

- When I start bearing full weight on my left leg.

Any other suggestions are welcomed.
Cedrik - Could you please add me to the ACL class of 2011?

[tone capone]

Wow, your Doc sounds helpful.

Things I wouldn't wait a week for:

Quad sets, flew your quad muscles if you can. Wth your leg straight on the bed, try and squeeze your quad muscle. Not just a flicker, hold it for a second if you can. 25x3 times. Sometimes they give you this board like thing to strap your leg down, fully extended for 10 minutes at a time 3 times a day. If you don't have that, do the quad sets and keep your leg fully extended and slightly elevated at rest. Achieving full extension is very important in the first few weeks of recovery. If you can't flex your quad muscle, for sure spend a good amount of time with your leg extended, heel on a pillow.

Did they give you a CPM? A machine that flexes your leg for you? Some docs don't... If not I would gently and carefully, if you can do it with your arms or something, maybe have someone help you, repeatedly bend your leg to around only 60 degrees to start, progressing ever so slightly each day until you get to pt. You probly won't even get to 90 degrees in the first week and probly shouldn't unless you clear it with your doc. Some docs don't emphasize the flexion in the first week, and so don't reccomend the cpm, but I used one and would highly reccomend it. DO NOT actively straighten your leg, only lift it slighlty bent and don't try and extend your tibia in a kick like motion.

Most people spend 5 days to 2 weeks on crutches. I started hobbling around around 6 days or so, and I sure as hell wouldn't call it walking. It took me over three months to walk perfectly again.

Full weight bearing can happen in that time frame but you will want to have your brace on for sure because you will be hobbling around on what feels like a useless appendage. Also, because of the trauma to your nerves and muscles, you will experience a hyper extending "snap back" like feeling that will at the very least scare the shit out of you. Wear the brace.

I would call your doc first thing tommorow and ask him what his protocol is for first week range of motion goals and what you could be doing at home to achieve that. I can only tell you what they had me doing and I had pretty good results getting range of motion back without injuring myself further.

Whatever you do, don't just sit around with a pillow under your knee and your leg bent at 30 degrees. That will bind it all up for sure.

[Cedrik]

amitshow2001: you're a member now, congratulations! Membership includes lots of pain, suffering, and a light at the end of the tunnel.

Lots of quad sets. Tighten the quad and hold for 10 seconds, relax 10 seconds, do 10x per set, 3 sets per session, 1-2 sessions per day to start. I just used a stopwatch and did 10 sec on/10 off for 3:20.

Easy cannonball. Lay on your back with legs straight up, gently let your legs flex downward. At the beginning, you'll probably have to hold the repaired leg and slowly lower it.

After several days you'll probably add heel raises 10-15x per set, 2-3 sets per session, 1x/day; weight shifts, leg lifts, wall slides, and knee extensions. Once you have your program from your PT, put it in spreadsheet form and write down what you do.

While the gimps are reading this post, I'd like to fill in some more blanks on the ACL Class of 2011 page. I'm missing the following graft types (surgery month is an estimate):
chefgrif, march
maaz23, march
edd70, march
Alpinord, march
FreakofSnow, april
BenWA, may
DRTMaverick, may
whtlizzard, june
Wintergreen, june
KFACTOR, august

GS828, kingdom-tele, and funvins: you get cut and drilled yet?

[coachjvinson]

Planning to have patellar auto graft acl recon asap - I like the idea of harvesting from the opposite knee d/t the fact that I am 18 months post op on the same knee for the acl recon - minor cartilage repair, lateral release (ouch - was a complete undiscussed surprise) and cyst removal from the acl (probably d/t previous partial tear)
~V

[amitshow2001]

Guys - 2 weeks post autograft and meniscus surgery. Off the crutches after 9 days but still quite a bit of limp while walking...Have been doing PT for almost a week. Questions - The thing that I am really scared of is whether I will be able to get my leg completely straight while walking....with the brace on it's still quite a ways away from getting straight. My extension is okay and flexion is post 90. Is this a normal recovery time or do you think I am lagging? Just wanted to set myself a benchmark of where I should be after maybe week 4 or 5.

Appreciate your inputs. Thanks -

[tone capone]

My physical therapist expected full extension in like 3 weeks I think? Full extension probly took me about 3 to 4 weeks I think? If you don't have it by 5 or 6, that is when you should be concerned, but not now. It also took me the better part of 3 months to really iron out my walking, there were alot of weird things going on for quite a while. It will fuck with you, be prepared. You are not lagging, at 4 or 5 weeks you should have pretty close to full extension, but walking might feel weird, especially when your leg is going behind you and extending.

I remember feeling looseness in my kneecap during that time, it really freaked me out. I was really worried that was going to be my new knee. I don't have that now, just constant pain in my kneecap when squatting which is not too sweet for skiing. I hope it is just "muscle weakness" still like the doc and pt says, and not permanent arthritis from losing half my meniscus! Good luck!

[Cedrik]

Questions - The thing that I am really scared of is whether I will be able to get my leg completely straight while walking....with the brace on it's still quite a ways away from getting straight. My extension is okay

My doc's protocol is full hyperextension within 4 weeks, in bold print on the handout.

When you're standing, stand with whatever weight you can on the repaired leg and work on full extension, which may be somewhat hyperextended (I'm naturally 7 degrees hyper). Never stand with the repaired leg limp and slightly bent. When you're walking, go slow and focus on fully extending the leg. It's easy to gimp around really quickly, but try to avoid that.

What kind of autograft did you get?

[zion zig zag]

Shit, I'm almost 3.5 months and I still don't have full extension. My PT isn't all that concerned, he says some people just take longer than others.

In other news, I can run about 1.5 miles nonstop at about a 8 minute a mile pace and it feels pretty good. It gets a little sore the day after I push it running or lifting but no real pain.

[Piggity]

I would like to hijack this thread and tell my insurance company to go FUCK themselves. Shady ass mother fuckers decided to cancel the "autopay" option on my account about 2 months after I tore my ACL, how conveniently timed for them. I opted out of surgery so no biggie but they are still shady insurance scum fuckwads.

that is all

[amitshow2001]

Guys,

5 weeks post the surgery...I could feel seeing slow improvements almost on a daily basis. I almost have full extension but can't get my leg completely straight while walking....I think it's still bent at around 10 degress while walking. Wouldn't getting full extension and walking with straight leg almost happen at the same time? What do I need to get it completely straight while walking......How long should I expect before I can walk normally with a straight leg?

[Cedrik]

Try walking a little slower, almost strolling, and consciously extending your leg. It's easy to gimp quickly and not concentrate on fully straightening/hyperextending your leg. More extension exercises might help, too. And fully straightening/hyperextending whenever you stand (cooking, brushing teeth, drinking at the bar, etc.) Glad to hear you're doing well at 5 weeks!