Cruciate ligaments :

allograph versus autograph? - - Posted by harley (harley), 7 January 2005

Have been researching the methods used for (ACL Reconstruction)  Would like some feedback on the two main techniques used  .  My own  tendons and bone versus a cadavor.  Pros and Cons, success rates, pain, etc.  I have to make a decision as my surgery takes place in two weeks for (ACL reconstruction, meniscus and bucket handle tear repair)  Second surgery on left knee. Not happy Thank You
Posted by Gab (Gab), 7 January 2005

Well I'll speak (write duh  ) from someone who has had the autograft. As far as graft strenght/stability, it has been said numerous time to be the best graft.

As far as cons, what I've suffered from so far: patellar tendon tendonitis at the bone plug sites associated with stairs, squats and pretty much everything involving putting pressure on it. At 7 months post-op it is getting better but until not too long ago, it was still VERY unpleasant. Also, now I have some bad klunking at extension which my OS thinks is a cyclops lesion (localized athrofibrosis). Apparently, it's not uncommon with the ACL reconstruction using the patellar tendon autograft but is not common either, if that makes sense.

The pros of the allograft are of course that you won't have to deal with all of that. The cons I heard (don't hold me to that) are that the graft may not revascularize as well, and that it has the tendency to stretch over time, which would lead to a bit of laxity.

From what I've read, if you were very active before you blew your ACL and want to resume to that level of activity and are not afraid to have a thougher rehab, go with the autograft. If you just want to get the thing reconstructed and don't really care about the rest, get the allograft.

I'm sure others will chime in but that's just my opinion.

Good luck!
Posted by harley (harley), 7 January 2005

Thank You for your response to my dilemma. allo vs auto for my (acl) reconstruction.  I am still not sure which way to go. Need to here of a few more experiences. I know everyone is individual in recovery and pain tolorence, and instances of side effects, I am basically just torn about the saftey of the allograph more than anything. Thanking you in advance    LR
Posted by Bballbaybee2110 (Bballbaybee2110), 7 January 2005

Hey Ya,
I've had an autograph... everything went perfect... literally... I had zero problemos ... i'm playing basketball at 5 months... everything is going awesome... well just thought i'd throw in my 2 cents!
Posted by jbluestein (jbluestein), 8 January 2005

If you're worried about the safety of the allograft, find out what company supplies the graft and what measures they take to ensure the safety of the graft.  My surgeon will use Regeration Technologies (RTIX) http://www.rtix.com/index.cfm

Risk from infection is now very low. Unlike organs the body does not reject a knee graft.

Ditto what Gab says, autografts are the gold standard for athletes, but, tend to be more painful and risky. Allografts require more time to re-incorporate, but have good results when rehab is followed properly.

Your surgeon is probably more adept at one or the other surgical procedure (auto vs. allo).

BE SURE TO USE AN EXPRIENCED SURGEON, one who does at least 50 or so ACL reconstructs per year.

Here's a couple of excellent links on the subject:

http://www.orthoassociates.com/ACL_grafts.htm

http://www2.arthroscopyjournal.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a0190453&nav=abs&special=hilite&query=%5Ball_fields%5D%28allograft+versus+autograft%2C%29


good luck, keep posting
Posted by libertynm (libertynm), 8 January 2005

I had an allograft surgery (4 weeks post op) and keep wondering how in the world I could have done this as an autograft.  

However, I too was very concerned about the possibility of an infection transferred through the graft.  My surgeon only does allografts and made it clear that that would be my only option if he were to do the surgery.  As he had an excellent track record, I wanted him to do the surgery, and therefore agreed to the allograft.

As I have had a lot of pain and swelling with this surgery, with just one surgical site, I think that having a second site for the graft harvest would have been unbearable.  Of course this is just my personal experience and everyone is different.  

Prior to my injury, I did a lot of yoga, and would like to return to it.  Kneeling can be painful after a patellar tendon harvest and therefore a patellar tendon autograft would make a number of yoga poses difficult to achieve.  Had I opted to find a different surgeon and do an autograft, I would have gone for the hamstring graft in order to return to yoga 100%.

Good luck with your decision!  (either way the success rate for this surgery is very high)
Posted by harley (harley), 8 January 2005

Thank You so much all of you; Gab, Libertymn, Jbluestein, and Bballbaybee2110;   You don't even know what it means to me to have your imput. Arthroscopy is not new to me, I have had both knees done for meniscus, bucket handle tears. They were relatively easy surgeries for me, of course not without some pain and immobility. but I was back on my feet within days after. Sleeping was the worst I think.  However the thought of a third surgery just doesn't set well with me and especially it being a longer and more involved one. With more pain and recovery, I am not one to sit still and hate the thought of being grounded for any period of time.  You all have given me great imput and I will take it all into account when making my final decision.  Especially asking my surgeon about his personal experience with both surgeries.  Good advice.  I wish you all a very Healthy happy New Year, and hope for speedy recoverys for everyone.  Thanks again!  LR
Posted by jbluestein (jbluestein), 8 January 2005

you're welcome harley, this is a great site and seems to serve us all well.

Now I have a question for this group:

interefence fixation screws, bio-absorbable or titanium?

I'm struggling with the decision.

Long term I'd rather not have the metal in my body, but, I am told they hold better than the bio's.

Also wondering since the allograft takes longer to incorporate, will the bio-screws absorb before the graft is done incorporating?

Your thoughts?

thans,


Posted by Gab (Gab), 8 January 2005

Hey harley, not a problem. Some people helped me out in here when I first joined after my injury so if I can help people out in return, it's only fair  

I understand why you may be reluctant of having this surgery after the arthroscopy, I'm having it the other way around (i.e. scope after the reconstruction) and the thought of pulling the crutches out, ice packs and pain meds makes my teeth grind. But hey as long as you keep in mind that you'll be (hopefully) better off in the end, that's how I see it.

jb, that's a good question. I have bio-absorbable screws in my knee and never thought for a second what would be the pros and cons of them versus titanium. But in my own humble non-professional opinion, I don't think it should a make a difference. The way I see it is that the bone 'regrows' around the graft AND the threads of the screws, which should make the entire joint pretty solid.

Here's a little story! When I was a kid I lived in a small village and broke my arm toward the end of a day on a Sunday night. My dad, a doctor, knew I had completely fractured both the radius and cubitus but we had to go to the hospital which was in a larger town about 45 minutes away and there was no way we could have gotten the X-rays and cast done that night so I had to sleep it off and went there the morning after. Well believe it or not, the doctor had to REBREAK the bones because they had started to fuse overnight!

Soooooo, my point is that if you have bone to bone healing and you stick a screw in there on top of that, it should be pretty solid!  
Posted by harley (harley), 8 January 2005

Dear jbluestein;
    I have also looked into your question about absorbable vs metal, I just have my own opinion about that. I think that I would rather have the interefence fixation screws because they are bio degradible, very strong , they have no protruding heads and they wedge themselves very securely in place so as healing occurs and your own bone grows back everything is extreemly strong then you are left with only your own bone and no metal.  I think what Gab says about screws and bone being stronger may be true to some extent, but for those of us who would like to get back to our natural state, as much as possible, would like it better not to have metal parts in us. I know its just a couple of screws, mabe no big deal.   But they could possibly cause some trouble down the road, I don't know.   I just like the idea of do your job and get the heck out of there   lol. Thank You both for your questions and answers, It gives me alot to think about  I like that.  Sincerely L.R.
Posted by jbluestein (jbluestein), 9 January 2005

thank you both.

I haven't heard of any long term problems with titanium screws, heard some about MRI interference, and perhaps slightly better hold.

I agree with you both, the graft should be pretty solid, my rehab approach will be conservative, so I'm leaning towards bio-absorbable unless there's a compelling reason not to.

I'll approach my OS with this.


Posted by murtaughdog (murtaughdog), 9 January 2005

Go with whatever your OS has the most experience and best success at!

Rgr
Posted by hottubpam (hottubpam), 9 January 2005

I had an allograft - unfortunately the OS who put it in was incompetent.  I have no complaints about the allograft itself, but the OS put it in too soon (I only had 90 degrees of ROM), AND he put it in WRONG.  He placed it in the far anterior notch.  

Anyway I developed a cyclops lesion and other scar tissue (neither of which the first OS diagnosed).  I finally fired him and sought a second opinion. 2nd OS operated and resected (removed) the mal-positioned ACL graft and a ton of scar tissue.

The story goes on, but is not relevant to your question.  Bottom line I do not have any concerns about the original choice of graft.  I think it depends on your age, expectations for post-op activity, your physical condition, a host of other things.

If  you really trust your OS and feel he/she is competent I would go with their recommendation.  I am hoping for another ACL reconstruction sometime down the road after we get this scar tissue demon under control.

Good luck
Pam
Posted by harley (harley), 9 January 2005

Dear Hottubpam, you've really been put through some tough stuff. Thank you for sharing that, I certainly will gather some strength from you. Your right about concidering , age, mental  and physical state, and type of rehab when making  choices about surgeries. I hadnt thought much about that until you brought it up.  Iam 54 yrs old and do stay in shape, but my excercise routine is very conservative at this time, it keeps me healthy. Mabe I should go for the allograph, and shorter recovery. Thinking hard on that! .
Murtaughdog,  You said it short and sweet.Sometimes thats the best way ! Thank You .

Bluejay;  Good Luck again on your decision! .  LR
Posted by jbluestein (jbluestein), 9 January 2005

Pam, so sorry to hear about your troubles with your first surgery, hopefully it will work out with a new surgeon.

I'm glad you posted, there are many success stories and if you read the literature 80-90% of ACL reconstructs work out well.

But, there are several stories where the surgery did not do what was expected.

It's important to read what people like yourself have to say, so we can all ask the right quesitons.

thanks,


Posted by Gab (Gab), 10 January 2005

Yeah, if you venture in the 'Soft tissue healing problems' section in the forum, you'll see a lot of folks who are stuck in scar tissue nightmares..  

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

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