I just tore MY ACL - My Local Genius Ortho is planning on Hammie Repair

[FredsTrees]

Well after reading about Altagirl, Snowtigress, altachic, vinman, buzzworthy and the strong minded Dr Mark i am sorry to report that i did a stellar job blowing out my acl last saturday 2/2/08 in Montana. I was skiing a steep ridge area, did 6 or 7 high speed turns in steep fresh snow, criss crossing a small 10-15 foot dome feature with fall away on either side. I went for a big right turn and turned back into the feature. My shovel caught some small wind blown crud (this was the downwind side of overnight and dominant winds). I compressed hard, and felt my ski turning uphill. Next I remember launch and a pop, then blackness as i slid to a stop 20 feet beyond my release.

There was a moment of panic as the pain hit hard and recognition of the feeling "pop" I had heard discussed so many times in this thread. I caught my breathe tried to keep myself from panicking, and even went back up to my ski. I put my head down, got my ski back on and tried on turn in the pow and the knee felt like it might give out. I ended up side stepping the run, skiing the flat out run and riding a groomer to the bottom.

So there you have it. It was an accident. I may have been going to fast, but wtf. I have been skiing for 25 years, i am 34 and nothing like this has ever happened. It followed perhaps my best day of skiing ever? Is there reason or did the statistics of skiing aggressively and in off piste snow finally get to me? I have little or no history of knee problems.I am a touch overweight, but i workout 3-5 a week, take glucosomine etc, have worked hard to stay strong and ready for my vacations.

The good news is the MRI shows a complete tear, with no other damage, minor mcl strain (?). My local young(39) agressive doctor prefers hamstring repairs. There is no doubt he is competent and credible, but he is not Dr Andrews, Dr Stone, Dr Mark etc, has not done 1000s of these.

I recently finished a L shoulder Open Bankart Repair by Dr Andrews 9-6-06, it was a second or a "revision" following scoping, and i felt I needed to get the best possible surgeon. The trip to Birmingham was a bit of a hassle, but worth it now. Dr Andrews insists on early movement. I did rehab as soon as i woke up, so did the acl repairs done the same day as me. So I am used to aggressive, and frankly i think movement promotes healing, so i am concerned that the hamstring graft actually forces an extended immobilization to let it heal? I intend to immerse myself in the reading and the advice of others.

Anyway I would really appreciate comments, i know we are beating this graft thing to a pulp, messing with my beautiful hamstrings has me worried. I have huge quads and strong hammies. I am worried that by messing with the hamstrings you actually add time to the immobility time, as you have to let this sit for 3-4 weeks.

My instinct tells me I am fine with my doctor and procedure, but all this sitting around and reading makes me nervous, please let me know what you think....

[drmark]

Dr. Andrews only uses the patella tendon. Since you had such a good experience with him, why don't you go back there?

[FredsTrees]

The problem with Dr. Andrews is the extra cost and time to travel down there, and a slight amount of family pressure to save on both.

Beyond that it is slightly less comforting to have to get on plane for follow ups. It was a bit mentally taxing to not have a close Dr. to visit and follow up with.

[fez]

you from montana? can't go wrong with dr campbell at bridger ortho in bozeman.

[FredsTrees]

i wish, i'm from colorado, popped my acl in MT last week, live in Philly, PA. thanks for the info....

[FredsTrees]

Have any of you experienced a bad hammie acl repair?

[Dexter Rutecki]

Live in Philly? Come up to NYC and have a Special Surgery guy do it, pretty much can't go wrong there.

[GoNads]

I've had 2 hamstring acl repairs on both knees and they are still there... after much more abuse.

[robgoose]

You may want to look at insall scott kelly in enycee

[Mofro261]

I have a hammy graft from 1989 that is still holding up bomber; I had another from 1995 that blew out again in dec 2006. I guess that puts me at 50% failure rate over a collective ~30 years.

Here's my $0.02. Go with what YOU are most comfortable with. If YOU want a patella graft, go get a patella graft from a competent doc. All doc's have a perference due to what they are most comfortable with, choose a doc that does the operation YOU are most comfortable with.

[Ski Moegain]

hahah i tore my lcl today
We can be torn whatever-CL brothers!!!

[Dexter Rutecki]

You may want to look at insall scott kelly in enycee

Yeah, that too. That's where I am now, actually heading in tomorrow probably to set up the spring surgery. Woo hoo...

[valleygirl]

I have to say that the knee has never given me any trouble since the hammie repair... however the hamstring is a constant pain in the ass. Pay attention to the recovery of THAT as much as you pay attention to the knee. I run and am constantly having to deal w/the cramping and tightness, 8 years later.

I opted for the ham as I didn't want to have two bum knees (single working mom)... but would choose differently if I had to do it again, knowing what I know now.

That being said, I ran a half marathon the year after the surgery and while I didn't walk REALLY well in the couple days afterward, it wasn't the knee that had me hobbling...

God love Dr. O'Neil.

but holy shit that constant motion machine I woke up to still lives in my memory and can burn in the fires of hell.

[FredsTrees]

Thanks for all the replies, valleygirl, that hammie thing sounds horrible...

Just to add another opinion in to the mix, a guy comes into my office today who spends 3 months a year Vail, and says he tore his ACL 18 years ago, had no other issues..so the doc tells him to not have the operation. He does rehab for 3 months, and he has been fine ever since. Not a single problem, skiing 20-40 days a year since....!

Wow I like that approach? Hows that for a surgeon that doesn't need to cut?

[ski_adk]

I opted for the hammy graft 6 years ago and haven't looked back since. The knee and hammy are both holding up fine.

[Woodlandclown]

Thanks for all the replies, valleygirl, that hammie thing sounds horrible...

Just to add another opinion in to the mix, a guy comes into my office today who spends 3 months a year Vail, and says he tore his ACL 18 years ago, had no other issues..so the doc tells him to not have the operation. He does rehab for 3 months, and he has been fine ever since. Not a single problem, skiing 20-40 days a year since....!

Wow I like that approach? Hows that for a surgeon that doesn't need to cut?

Everybody I know that tore an ACL and did not fix it, would not recommend not doing so now. You would have to keep your leg muscles super super strong to compensate and it can lead to problems down the road when you are older. I'd get the surgery done now while i was young and in good shape. I wouldnt consider not getting the surgery. Which by the way will be hamstring--recommended by my doc. Everyone I know that has had it done (including the doc doing it) are skiers and athletes and all have had positive comments about it.

Not to hijack the thread, but I cannot seem to get past 118 flexion in my injured knee. Extension is fine. Maybe some of the torn ligament is in the way or something? Kind sucks--I had wanted all my ROM back before surgery. I guess i still have two more months to work on it, but its been two months and nothing yet. Maybe i am just being wimpy and I just need to go through a lot of pain before it will bend more? I finished PT for now--didnt want to burn up the visits I have for the year before surgery.

[Fritz]

Firstly, I'm 33. I opted hammy on July 1st 2007 and the doc cleared me for skiing on December 1st. 5 months and I came back really strong, maybe too strong as I broke my tibia/fibula hucking into rocks on my 15th day of the year. Just hit your PT hard, don't be a pussy, and you'll be fine. Other than your doc, PT is the most important part. Don't fucking slack or you'll be sorry.

[FredsTrees]

Thanks for all your replies, and Fritz, right on dude, i get it, i did a open left shoulder repair rehab that was downright grim in nature...so am ready to take prisoners in rehab for the knee....

I found a former US SKI Team doc with high marks from others lives in my town, appointment tomorrow. MY shoulder PT guy weighed in with avoiding autograft , as he feels recovery time is longer on the harvest site, considering i am a competitive sailor and have National Championship on May 25th, 2008.

I probably should have mentioned this to you all but i have intense competitive commitments for sailing regattas that start end of May this year, with a major event coming every month thru May 2009. So i need unequivocally the best surgery with the fastest recovery time.

Does anyone here think i can participate in a regatta on a J/24 at 3 months, or is this unrealistic ? (at first i thought these were out but now i am starting to wonder if i could maybe do them)

Surgery date Date is Feb 26th...

[Stymie]

Not sure the hammie graft will be up for it 3 months post-op... Can you wait until after the regatta? Perhaps sporting a Defiance brace (or similar)...

I've had two patella tendon grafts... no way I would have been ready either time to do anything competitive after only 3 months.

I would, by the way, back the NYC Hospital for Special Surgery- Russ Warren (NYG team doctor) did my knee in the 90's. Not sure if he still is taking patients who aren't million dollar footballers, though.

[drmark]

Fred, you have nothing but good things to say about Dr. Andrews. He is a little hard to get to.

Everyone hears horror stories about the horrible results that theri stupid doctors bought for them.

You only have the rest of your life hanging in the balance.

Why in the name of God, would you want to go anywhere else? Surely, if you have money for ski trips, you can affort to get to Burmingham. Unless your life isn't worth that much to you.

[FredsTrees]

Thanks for the reply Dr. Mark, always good to hear a strong educated opinion and am appreciative that you are taking the time to point out some obvious issues.

My 9-6-06 shoulder was a revision surgery to Bankart scope repair in 1995. I wont share the rehab experience with Dr. Mark because it will only add to his strong opinion on why using the well known reputable guy ( he was the head of the biggest department of the biggest hospital around) can be a mistake, or how risks are numbers that can bite you in the ass. I dislocated the shoulder again in 3 years.To me a failed functional outcome is one that doesn't work past a reasonable time, symptomatic, like sore hammies or patella tendons,dislocations. A good surgery can have incredibly quik healing and recovery time without compromising the repair.

But my knee is in good health, despite the total tear of the ACL, w/o serious damage to other bits and this is a first surgery to my knee. The surgery has a high success rate 95% for functional outcomes. In short i am a great candidate for total recovery. I realize this is simplified, but wtf....i don't need the miracle AS much, nor do i need to tempt fate with another less than good outcome...

I believe Dr. Andrews made sense because of his experience level, his personal skills and his personal assurance he would get it right. The shoulder is a complex beast, and the success rate is way lower and fraught with issues post op. My shoulder was a snake pit of laxity and tears. The man spent a lot of time with me, asked a lot of questions about me personally, took it all in and then looked me in the eye and said to me he would take of me and , motherfucker he did it. I could tell he was used to patience with super high activity levels, competitiveness and massively high expectations of performance, will power and goal setting that were always too early, too hard and too fast. I was facing the deterioration of my time on the water and on on terra firma, and he set me straight, told me to let it heal, but after that to work my ass off and would be back on the water.

Grab a tissue here comes the good part.......

In July 2007 10 months after my surgery, i won a lifelong goal for myself by winning a North American Championship. I could not practice as much or be prepared like usual, but none the less the trophy is sitting next to me. I was able to compete with a huge smile on my face and happened to win. How cool is that? I owe Andrews and my PT tons of credit....

I don't need to be told how hard to work or how (not to be a pussy, that such great advice isnt it? Dont be a pussy, go huck yourself of that bridge asshole) what i need is clear confident responsible competence that matches mine! Seems pretty realistic to me....

Whew...rant over.....anyway i see Dr Ski tomorrow & should get cleared for my surgery by my General Practitioner, and will be checking flights to Birmingham, AL..i"ll keep you posted...thanks for sort of giving a shit...

[4btn]

I blew my ACL back in Feb '05 and had surgery in late March '05. I had no meniscus damage and used the hami graph after talking to multiple ortho doctors and friends/acquaintances that had ACL surgery. The doctors warned of patellar tendonitis if the patellar tendon was used for the graph. Of the friends/ acquaintances that used the patellar tendon, all were experiencing an uncomfortable amount of patellar tendonitis. I set a goal of riding in the triple bypass (cycling 120 miles and 10k vert) which was 3.5 months after knee surgery. Since I had no meniscus damage before surgery, I was able to go into surgery fully trained. I was cycling at least an hour 5-6 days/week and doing light lifting a couple times a week leading up to surgery. The exact timeline after surgery has escaped with time, but within about 2 weeks, I was able to ride a stationary bike and make full revolutions with the pedals. I iced my knee every day all day at work for the first couple weeks and went to physical therapy for the first couple sessions. After I realized my physical therapist was just reading the workout from the list my doctor gave him, I just got the list from the doctor and did the workout myself (although, I have heard of many PTs very well worth your time). I did A LOT of cycling all under my doctor's permission and did PT exactly as the doctor recommended. I successfully completed a few 100 mile rides and completed the Triple something around 8 hours.

Before my surgery, my knees never had any pain whatsoever. I now have a very small amount of pain in both knees after very high impact activities such as a hard run at race pace or skiing hard bumps (which I haven't done since moving to the PNW ). The little pain is nothing that limits performance or is even uncomfortable but something to consider for 30, 40 years down the line. I imagine once the ACL is ruptured, no matter what, it is something that will affect the body down the line, regardless of surgery or graph. Pain in my surgery knee is for obvious reason and I believe pain in my other knee is due to over compensating while rehab. I've talked to a couple people that have had the same issue, so hopefully you can avoid this. Even though people claim 100% percent recovery, I really believe it is rare that someone who never experienced any knee abnormalities whatsoever will return to that same state, especially someone participating in a sport that stresses the knee as much as skiing. With that in mind, even though I do have a little pain a few times a month, I feel it is very close to 100% recovered and perfectly acceptable.

I learned an important bit of info from a buddy that is a med student and has had two or three ACLs replaced. The exact timeframe is worth asking your doctor, but I believe it's something like 6 weeks to 2 months after surgery is when the graph is weakest. Initially the graph is strong due to the fact that it was just removed from the hamstring/patella. Once the graph has fully adapted (blood flow and whatever else a tendon/ligament does) to its new position in the body it is again strong. Between these two times it is most venerable. This time can coincide with the same time you are starting to regain confidence in your knee and start stressing it more, something to keep in mind.

I've never done any sailing, but hopefully my cycling rehab experience helps you gage your recovery. I have been very happy with the hamstring choice. Best of luck!

[FredsTrees]

I HAVE DECIDED TO MAKE A SUMMARY FOR EVERYONE BELOW. I AM NOT A DOCTOR. I have a BS & BA dual degree from a elitist NE school and 3 re-constructive surgeries, 2 shoulder, one ACL.

Research, the cornerstone of all the information discussed here. I am learning that what your buddy tells you is just that, consider the source. Remember Mikey from the Life commercials who was killed by Pop Rocks and soda? If you are an avid reader and feel like researching peer reviewed material check out this link.http://ajs.sagepub.com/. There are other journals and a lot of material to go thru. You can read all the abstracts and if you feel like it go for the individual subscription and have access to the documents, there is mounds of good info here. This is hard research. If you want advice like "don’t be a pussy", go to the "I huck myself off everything" thread....

The functional success rate for first time ACL reconstruction most publications put it at 85-95%; see #5. This is for 1st time surgeries and not “revision” surgeries. I am not commenting on revisions, whole different animal.

UPDATE 5/27/2011 I am adding a scoring system for people to asses there own activity levels. (It is the "tegner" score).

Step #1
Please assess yourself first on what you did PRIOR to your ACL injury on the scale, and then rate what your intention is afterward. If you used to be a world class Motocross racer and you intend to retire based on your kneee injury and be an anylyst for Fuet TV after, you would be a 10 Prior, and then a 7 after. If you are a recreational expert skier and plan to rehab and return back to that level, you are a 6 prior and a 6 after.If you are a 57 year old grandmother of 8 who tore your ACL walking down icy stairs with no active sports played, you are a Level 3 going to a Level 3 after.

Level 10 - Competitive sports- soccer, football, rugby (national elite)
Level 9 - Competitive sports- soccer, football, rugby (lower divisions), ice hockey, wrestling, gymnastics, basketball
Level 8 - Competitive sports- racquetball or bandy, squash or badminton, track and field athletics (jumping, etc.), down-hill skiing
Level 7 - Competitive sports- tennis, running, motorcars speedway, handball
Recreational sports- soccer, football, rugby, bandy, ice hockey, basketball, squash, racquetball, running
Level 6 - Recreational sports- tennis and badminton, handball, racquetball, down-hill skiing, jogging at least 5 times per week
Level 5 - Work- heavy labor (construction, etc.)
Competitive sports- cycling, cross-country skiing,
Recreational sports- jogging on uneven ground at least twice weekly
Level 4 - Work - moderately heavy labor (e.g. truck driving, etc.)
Level 3 - Work - light labor (nursing, etc.)
Level 2 - Work - light labor
Walking on uneven ground possible, but impossible to back pack or hike
Level 1 - Work - sedentary (secretarial, etc.)
Level 0 - Sick leave or disability pension because of knee problems

Write down your Tegner before and after, then read the graft guide.

1. Auto graft patella tendons are the "gold standard", have the most frequent usage rate and have a long running refinement of technique, used by most professional athletes. Dr. Mark (not Dr Mork ) uses a contra lateral (opposite side) patella graft and accelerated rehabilitation protocol stressing early movement and weight bearing made popular by Kenneth D. Shelbourne, MD. This is an excellent option. Well known and highly respected amongst the pro athlete crowd, Dr. James Andrews does a same side patella graft with high profile clients such as Donovan McNabb. Negatives include having a slightly higher (OA) osteoarthritis occurrence than hamstring grafts, also have higher incidence of graft site pain, morbidity, numerous recent studies. Rigid Bone to bone fixation and high tensile and stiffness are bonuses, providing excellent outcomes for high impact athletes looking to get back on the field. Nearly every single NFL player does Patella. Recommended for Tegner 6+. Nearly all (95%) of professional cutting athletes with Tegner scores of 8+ get Patella.

2. Zombie aka dead guy aka cadaver aka Allo graft are becoming more popular. There is significant gain in not having a harvest site, therefore reducing pain and rehab associated with this type. There is a fair amount of development going on in this area, mostly to do with things like the PIG LIG and Dr. Stone in SF, or using stem cells to augment the vascular health or regeneration process. Recent reports have noted a traumatic rupture rate of autogenous ACL reconstruction of 2% and an allograft rupture rate of 15% (references). In the case of Allo grafts a low level of immunologic reaction can weaken the graft and cause early failure. There is still a risk of infection, disease transmission, however remote this is a risk not yet 100% solved. Doctors I have spoken to are spooked by this graft especially when referring to graft failure and the lingering risk of graft source pathology. To solve this irradiation has been introduced and there is research that shows higher failure rates for irradiated tissue, Rappe, Horodowski. May 21, 2007. In addition there is debate about how long the vascular health of non native tissue takes, see #4. None the less the success rate is very high for this surgery despite some of the controversy. A Doctor that addresses these issues accurately and is comfortable should be considered. You can see there is a ton of evidence I found that gives it a thumbs down, however there are a lot of successful allo grafts being done, and comfort with the procedure and all the risks still can fall into the 85-95% category of success. Update 5/27/2011. The tegner score is a score given to the activity level of a patient. You have to read this research on the people considered active like TGR readers, and allografts. 25% Failure Rate. Strongly discouraged for Tegner 6+. Okay for Tegner 5 down to 3. Recommended strongly for 1,2,3 on the Tegner score.

3.Hamstring Auto grafts have several variations. Although Hamstring grafts have shown greater (although small in scale, as in mm significance) laxity in research 6, 12, 24 month studies, there have been significant improvements in technique that have specifically addressed this regarding anchoring and sutures. A variety of methods are used including cross pin, endo button, screw and post, or belt-buckle staple technique – each can produce favorable results. Doctors are now using the "Quad" graft, the double braided hamstring and are attaching with reliably strong biodegradable tacks. Subtle changes such as a slight twist to the graft and the careful placement of the tack into the graft attachment point have improved results and sharply strengthened the auto graft (of self, meaning same ) tissue . Doctors are sighting recent, (as in the last 2 years) research pointing to incredibly high graft strength, although there is till some lingering concern about the tissue to bone “attachment point”, often cited as the most significant point of any graft surgery. The other major issue remains tunnel widening. Examples of this include the following ; because the graft is smaller in size to the tunnel it is strung thru, the graft itself to move back and forth across the tunnel, widening it and causing a "windshield wiper effect" where it slowly stretches the graft out. This remains a controversy for this graft syleIn my case 2 of the top knee doctors in Philadelphia are now doing Hamstring grafts "exclusively" as of 2-15-08 citing best rehab, low graft site - itis, and stronger and biodegradable tack and sutures points. Each stated this is what they would do to themselves (the salesman doctor!) and felt the minimal long term stretching due to the windshield wiper effect was negligible and heavily outweighed the downsides of the other graft choices. Reccomended for Tegner 4-7 Scores. Not Reccomended for Tegner 7+ .

4. Comments about the tissue from the graft and when it is repaired or healthy; there has been some controversy about when the graft is healthy, strong and part of the body. The tissue is alive within months and becomes your own vascular tissue at some point, this happens well before 12 months, perhaps as quick as 3 months, and there are suggestions your own tissue does this faster. This happens for Allo grafts as well, but there is some indications that this may take longer in Allograft repairs. Some of the reading indicates that, 1-2 months is the time when the vascular health returns.

5. Take your Tegner score and write next to it your perception of the Doctor's ability to perform your graft choice. This perception of the abillity to perform your graft choice should be painted by the number of times he has done the surgery, how old he is (meaning experience), and if you have heard positive feedback from similar Tegner score patientse to you with his graft style. DO NOT PERCEIVE A DOCTORS ABILITY TO PERFORM YOUR GRAFT CHOICE ON PROFESSIONAL TEAM ASSOCIATION, THESE ARE OFTEN SOLD RIGHTS FOR MARKETING AND NOT A MEASURE OF A DOCTORS SKILL OR FUNCTIONAL OUTCOME. Research shows that the best ACL recon result is actually more dependent on the comfort level, expertise and experience of the surgeon and NOT the actual graft type. Find good competent doctor and consult.

Now decide and quit contemplating.

[drmark]

There is alot scuttlebutt as well information in the medical literature that I dont necessarily think is so. Especially when the issue is related to ACL surgery with the opposite patella tendon. One of our patients made this video one month after their opposite patella tendon surgery. His result is typical for this procedure. I continue to challenge everyone to show real evidence of any more superior result with any other graft source.

http://www.youtube.com/watch?v=1dTn39NNN50

[FredsTrees]

I am scheduled for Surgery 1 week from today, thanks for all your input, and for reading my never ending posts....

Enjoy your turns if you can make them, cause I'm out til next fall....

I just watched the Dr. Mark video which basically completely negates my entire summary. That is some insane shit....4 weeks...? Great now I am not resolved...