please give advice an graft selection, im freaking out.

Cruciate repair, allograft, autograft, synthetic ligaments. Ligament braces.
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please give advice an graft selection, im freaking out.

Post by BIGTEXAS2008 »

hey guys this is my first post and ive been reading everyones story about their experiences. well, im due to have surgery on NOV 19 and im still unsure about what graft to use. i dont know whether to have autograft (BTB) or allograft anterior tibialis(the surgeons choice) the doctors are getting kind of upset because i keep switching back and forth. but its my life and body so i have to be sure. just a little background so everyone can offer their opinion. i first injured my left knee in 2006 playing flag football. the OS confirmed that it was an ACL tear and recomended surgery. i declined surgery due to fear and continued to play flag football i just trained to be a QB which didnt required much running around, i was able to still enjoy playing sports although not at a high level and i thougth id be okay , i wasnt having any pain,swelling or instability and i felt good. well this past october the worst happended and my right knee buckled (my good knee) and i heard a pop, i immediately knew it was a torn ACL. so yes i have two torn ACLs. the problem is that my right knee feels really loose and theres a dull pain in it, where as when i hurt the left one , there was no pain or loose feeling at all, in fact my left knee hasnt buckled in almost 3 years even while playing on it. so i saw the OS and i told him i dont really have a choice but to have the surgery if want to run again because now i cant to do anything. the surgeon is not going to a bilateral acl repair so i just decided to have the right one done because its probaly in the worst condition. the OS suggest that i have a patellar autograft. and thats what i was going with, but when i went back for my pre op visit i changed to a allograft(anterior tib tendon) . i saw videos of the autograft and that is a REAL invasive procedure, they are doing a lot of jamming ,cutting, SAWING and its looks like some major pain afterwards. im not real big on pain medicine so i dont want to be doped up all the time. so i switched to allograft because its less invasive and i figure id still be able to play QB which doesnt involve a lot of cutting and running, i dont think the doctors wanted me to do that because they sort of frowned and said it was my choice. they arent being real helpful, i just want someone to say listen the autograft is your best choice if you want to play again and not have any worries or say that the allograft will still be solid choice but might be not as effective. they are sort of nonchalant about the whole thing and leaving it up to me. I DONT KNOW WHAT TO TO PLEASE HELP. sorry about the long post. thank you everyone for your help
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Re: please give advice an graft selection, im freaking out.

Post by BigSkyGirl »

How much research have you done on the types of grafts and the rehab protocols?

All of us ACLr's have had different procedures with different rehabs and different outcomes. If there was one generic answer there would be no need for this board.

Unfortunately you are not going to find a "right" answer here. There are so many factors to consider, nature of injury, age, activity level, strength, Dr's preferences, ability to rehab, and on and on.....you will have to decide what is best for you and then commit. If you have not been doing so I would go check out the post-op diaries and see that for the most part the allograft is an easier recovery. It is less invasive and you are not dealing with a secondary healing site. The autograft is your own tissue, for me that was a better option but there is the issue of dealing with the donor site healing. Most everyone recovers pretty well and gets back to a normal life, for some it was very fast others it took awhile.

As far as pain, everyone is different. It is no big deal to take pain meds when you are in pain for a few days. You are not going to get addicted...you will get constipated tho' so get some stool softener.

As far as the videos you saw, keep in mind that the only part the allograft does not go thru is the harvesting, there are still portals and plenty of jamming and major pain afterwards but again everyone is different you may have very little pain.

Don't worry, whatever choice you make will be a good one and it will get you back to doing the things you lie to do. The easy part is the surgery - you are asleep. Enjoy it 'cause when you wake you the hard part starts....re-hab.

Keep us posted.
02/11/08 - LK ACL/MCL tears, fibula fracture - skiing in CA
04/14/08 - ACLr PT autograft
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Re: please give advice an graft selection, im freaking out.

Post by feeny »

Hey man, sorry to hear about your injuries.
You dont need to freak out - as bigskygirl says:
BigSkyGirl wrote: Don't worry, whatever choice you make will be a good one and it will get you back to doing the things you lie to do. The easy part is the surgery - you are asleep. Enjoy it 'cause when you wake you the hard part starts....re-hab.
Thats true - all choices will do the job, and you will need to work hard no matter which path you choose to get back to your peak - but it is very doable - and quite a journey at that. You will see top athletes returning to their former heights with every type of graft choice imaginable - and no reason why you shouldnt either.

The procedure isn't pretty but you know what - unfortunately the leg is going to be bloody sore - it will be bloody sore no matter which one you get. My pain came not from the knee believe it or not - but from my shin and instep - which, due to bruising above had swelling ... and it hurt so much that when I got up and all the blood moved around, I literarily fainted. Don't freak out though - its not good - but thats only the first few days - week 1 will painful, week 2 less so - and then it gets better - much better - really quickly too - thats what makes it a kind of a discovery journey - I still reflect on it kind of like I was a bird learning to fly again - in its own way its a bit mystical.

So, even though there is more or less morbidity in some of the procedures - in terms of post-op pain, my opinion is you are comparing extra super bloody painful to extra extra super bloody painful - won;t tell the difference - if you know what I mean... they all drill into two of the biggest bones of your body etc etc.

I personally had 3 choices open to me - patella autograft, hamstring autograft, and for extra $$ could have gone for the allograft too.
I chose hamstring - why? Because my research showed me that patella autografts were associated with long term kneeling pain, and allografts were possible candidates for later revision surgery. A quad bundle construct hamstring autograft was near enough as strong as any method, without chance of rejection. The downside of the hamstring is that in deep flexion motions, the leg will always be minorly deficient. I researched what sports that may affect - and I came up with a shortlist of "wrestling - when hooking your opponent with your leg" and "various schools of gymnastics"... none of which were my cup of tea. But kneeling.. I didn't want to have kneeling issues... so therefore chose hamstring.

Today I am playing soccer again- at the top of my game - doing all the things I love.
I guarantee, whatever choice you make - you will be able to get good outcomes - and with a bit of effort - be satisfied that you have returned to your goals.

I wont tell you which to get, only which I got - but I will advise you thus: Whatever your choice - make sure your surgeon is 110% COMFORTABLE with that method - and that they do 10000s of them like that! I.E. dont get an allograft specialist to harvest your hamstring etc etc!

Lastly, there are different schools of thought as to potential recovery time between graft choices. My own opinion is that they are all the same really - because what makes the most amount of difference to recovery is the patient themselves - both physically and mentally - and that just takes as long as it takes - nothing to do with graft choice these days!

GOod luck - keep us posted!
Sep-05 ACL rupture, Medial mensical tear, MCL rupture
Oct-05 Had it all repaired (hamstring graft, meniscal rivet)
-and then-
4.5 Months post-op Snowboarding like a demon
7 Months post-op Successful return to indoor soccer (YEH!)
-and then-
Mar-2015 Arthroscopy to fix meniscus
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Re: please give advice an graft selection, im freaking out.

Post by drmark »

My response will probably tick many people off, but I never care about such things.

One rule I have always followed, is to listen to what people say, and especially listen to what the DON'T say.

While, I never do any ACLR but patella tendon repairs, you probably should have an allograft with this surgeon.

The auto PT is without close second, the most difficult techinical operation to do. The reported results in excellent hands-and that means single surgeon series, rather than meta-analysis far surpass all other results. Some docs have mastered it, but most have not. If your doc suggested a soft tissue allograft as his/her first choice, that you should either had that, or find another doctor because of what he is NOT telling you.
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Re: please give advice an graft selection, im freaking out.

Post by BigSkyGirl »

Definitely make sure your OS is comfortable and proficient in your choice. I had one that talked about allograft, then I had one that talked about autograft (PT) and he instilled such confidence in me that even tho he was relocating from the area shortly after my surgery I went with him and his graft choice.
02/11/08 - LK ACL/MCL tears, fibula fracture - skiing in CA
04/14/08 - ACLr PT autograft
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Re: please give advice an graft selection, im freaking out.

Post by BIGTEXAS2008 »

thank you everyone for your responses. i think i might have mis stated something though. the OS wants me to go with the patella autograft. i switched to the allograft and the OS said that if i have the allograft he would do it with the anterior tibialis tendon. i was reading dr marks last post and i think i might have stated it incorrectly. but i appreciate everyones thoughts. thank you very much
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Re: please give advice an graft selection, im freaking out.

Post by jathib »

BIGTEXAS2008 wrote: . i saw videos of the autograft and that is a REAL invasive procedure, they are doing a lot of jamming ,cutting, SAWING and its looks like some major pain afterwards. im not real big on pain medicine so i dont want to be doped up all the time. so i switched to allograft because its less invasive and i figure id still be able to play QB which doesnt involve a lot of cutting and running,
Hate to tell you but there's going to be a lot of jamming, cutting, sawing and major pain afterwards no matter what you do. None of the procedures is pain free. They all involve putting a new ACL in place of the old. When I had mine done way back when there was only one choice, and that was using the patellar tendon. It has served me well for 18 years. There's really no best choice, they all have advantages and disadvantages. In your case you should choose your surgeon first and let him make the recommendation. Make sure he's comfortable with the procedure because if he's not it won't matter what you choose if the surgery is botched.

Be prepared for pain, be prepared to take pain killers and be doped up. It's all only temporary. I never care about such things either. I just pick a surgeon and let him be the expert.
drmark

Re: please give advice an graft selection, im freaking out.

Post by drmark »

The reported faiure rate of allos in young acitve people is just bout 25%.
In my not so humble opinion, a failed "minimally invasive" procedure that needs to be redone causeing an athletes to sit out another year, immediately qualifies as a "maximally invasive" procedure.
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Re: please give advice an graft selection, im freaking out.

Post by BIGTEXAS2008 »

so just go with the doctors choice? i know that the autograft is the best overall choice , but there are so many unknowns , how will i react to being under anesthesia,how much pain will there actually be , how long will it take before i can put weight on it. i just want to do whats best for my body, i have never been to the doctor,never been stuck with needles,never had any procedure of surgery what so ever, so imagine how traumatizing this is. i dont know what to do . :'(
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Re: please give advice an graft selection, im freaking out.

Post by jathib »

I had my first surgery at age 15. There are a lot of unknowns the first time but I wasn't traumatized by it all. This stuff gets done thousands of times a day. I just had my 20-something surgery two days ago on my shoulder. No big deal.

If you know the autograph is the best choice then just do it. The anesthesia will be fine, you go to sleep, you wake up and it's over. They can give you meds for nausea and all that. There's going to be a lot of pain, that's why they give you pain killers. Just get used to the idea and take them before it gets bad. Keep ahead of it and you'll be fine.

If you really want to do what's best for your body then quit playing football and take up knitting.
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Re: please give advice an graft selection, im freaking out.

Post by feeny »

Nothing wrong with getting the opinions of a few doctors - I shopped around before I made my decision.

Treat it like buying a new car - you'd do more research for that wouldnt you?

Well, I got news for you - I reckon your knee is a much bigger investment than that new car - so shop around!

Sep-05 ACL rupture, Medial mensical tear, MCL rupture
Oct-05 Had it all repaired (hamstring graft, meniscal rivet)
-and then-
4.5 Months post-op Snowboarding like a demon
7 Months post-op Successful return to indoor soccer (YEH!)
-and then-
Mar-2015 Arthroscopy to fix meniscus
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Re: please give advice an graft selection, im freaking out.

Post by BIGTEXAS2008 »

well , jathib , if you do play any real sports , you know thats not going to happen, thats why im having the surgery, so i can continue to have an active lifestyle, i wish it was as easy as youre making it seem. this is my first go around. itd be different if i would have been through surgery before.
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Re: please give advice an graft selection, im freaking out.

Post by Kaputt_Knee »

Rudeness, Mr Texas, is never needed and your last comment was extremely rude! But I'll leave it to Jathib to respond if they wish to.

I have had 5 ACL surgeries in my life - 2 artificial ligaments, which both failed after about 12 months each and 3 autografts. Two of the autografts are fine and are extremely strong. The one that "failed", was due to the non-specialist doctor placing it incorrectly. It had to be removed. OK I have problems kneeling because I have had two patella tendon grafts taken - so what apart from church I don't need to kneel in any of my sports.

The moral of this is the same as everyone has said - find a doctor you trust, ask him what he does on a daily basis and go with that. There is NO shortcut to the rehabbing if you want to return to your "real" sports.

FYI my "real" sports are: skiing, mountain hiking and climbing, paragliding, sailing and scuba diving, but then I'm an individual, not a pack-rat! I also teach sports in college. Additionally I teach disabled skiing, and that is REAL sport to the participants. Try launching yourself down a hill you cannot see, that takes courage as well as belief in yourself and your partner.

The surgery is invasive whether you have an allograft or autograft. There is no quick fix. If that is what you are after, you lucked out when you blew the ligament.

1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee
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Re: please give advice an graft selection, im freaking out.

Post by BIGTEXAS2008 »

im being rude, and that last statement by him wasnt rude, please. look, im not trying to make enemies but your making it real easy. i know the rehab is not going to be easy im not worried about that. i just dont know if the allograft or the autograft will be best for my condition.im not looking for shortcuts i know either way its going to hurt. but im new to all this, i have no idea what to expect, i know you and jathib are seasoned vets but im not and hopefullyl this will be my last experience ever going through this. i thought i could let my guard down in here because there are people going through the same i was and theyd understand but i see im going to have to beaware of people trying to be negative. i didnt expect this, but it sounds like you and jathib are trying to challenge me in some way and , what are you guys getting at?
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Re: please give advice an graft selection, im freaking out.

Post by Kaputt_Knee »

We are not challenging you, but to me, I can't speak for the others, it seems you are not really reading the answers you've been given. Plus your choice of words has been maybe a little ill-advised, so that you come across as being rude.

Everyone has said that you should go with the preferred graft of the surgeon concerned. If you don't like that, then find a surgeon who earns their daily bread doing the graft you prefer. I had to have a general trauma surgeon do my patella graft - I had no choice as he was the "approved" surgeon by my Worker's Comp scheme. He was incompetent - took too much and placed it incorrectly. He is a brilliant trauma surgeon from what I have read but is not a knee specialist and he messed up because of that.

As everyone has repeatedly said - find a surgeon who specialises in knee surgery and then go with his choice.

I take it that you are relatively young and rightly nervous about the surgery. If you are still unsure then cancel this Wednesday's surgery and do some really hard research here on the information pages, looking for a specialist you can get to not only for the operation but also for the rehab and follow up. Check if they work with a rehab physiotherapy practice - close partnerships usually produce good results to as they talk to each other should there be any questions. In the interim you can work on your pre-op fitness as going into surgery fit certainly leads to a quicker and more successful rehab. Strength training using close-chain activities will not cause any further damage - leg presses, elliptical trainers, stationary bike, etc. all help maintain quad and hamstring definition whilst waiting for the surgery.

There is a lot of information here and on the Net in general. We cannot make the decision for you. I have a really good hamstring double bundle but it is only 13.5 weeks old - but I have to say that the rehab this time around has been relatively easy because my PTs know and work closely with my surgeon.

1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee
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