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Torn ACL: Best surgery option for skier?

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Mrvic.
Posts: 1033 - Karma: 154
So I just tore my ACL last week and gonna get surgery next Thursday. For all of you skiers who have gone through this, what option did you do? I am thinking patellar or hamstring but both have negatives. By next season I want my knee to be able to take the same jumping, rail, and urban impacts it once was without pain.
I appreciate the help
Jan 18 2012 2:22PM
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ski_ENDUB
Posts: 2535 - Karma: 86
I'd avoid the hamstring, I havent heard many good things about it since afterward you're not only rehabing your knee but also your hamstring. also there's the extra pain associated with that procedure
Jan 18 2012 2:25PM
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jhackbeez
Posts: 2136 - Karma: 258
Hamstring is the strongest graft you can do, since it is coming from your own body. I had it done in April of 2010 from the same leg and it was totally fine. Just rehab a ton before you have surgery and a ton after. If you want a faster option do the cadaver or whatever. The patella option will leave your knee numb for the majority of your life.
Jan 18 2012 2:41PM
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jhackbeez
Posts: 2136 - Karma: 258
Oh and I skied exactly 6 months and 4 days out of surgery, mainly because i was so diligent doing rehab and riding a bike almost everyday.
Jan 18 2012 2:42PM
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Capernicus
Posts: 382 - Karma: 218
Listen to your Doctor. The placement of the graft and your rehab matter more than the graft itself.

I used a hamstring graft my first time around then later on the same knee, a cadaver graft (no, my hamstring graft was not weak, I was not fully rehabbed at the time).

I would seriously look into getting a cadaver graft but mostly do what your doctor says. Get a second opinion too.
Jan 18 2012 2:53PM
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aquinn
Posts: 824 - Karma: 217
above the knee amputation
Jan 18 2012 2:58PM
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R-B-B
Posts: 915 - Karma: 28
Don't do a cadaver if you are active/fit/young. It is more apt to be rejected by the body.

I had the patella tendon graft, in response to the above poster, my knee is not numb and I began skiing about 7 months post-op, regardless, the nerves within the knee are put through a lot of trauma and it is very common for spots in the knee to become numb no matter which graft/surgery is done.

Whichever one you decide, you will be doing exercises based around each leg muscle, calf, quad, hamstring as well as the tendons within the knee. I also suggest asking your surgeon which graft he has performed most often, just so he is more comfortable doing yours
Jan 18 2012 4:07PM
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MaryO
Posts: 2583 - Karma: 5,996
Isn't that usually a decision made by the surgeon! I have a cadaver ACL, but that's cause I'm old! I've had a great luck and recovery, skied cautiously 5 months post op.
Jan 18 2012 6:15PM
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3mania
Posts: 2624 - Karma: 10,488
Patella Graft.
Jan 18 2012 6:16PM
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atomic1824
Posts: 359 - Karma: 293
Your own patella is the best. Harvesting the patella includes pices of bone on both ends of the patella tendon and your femur and fibula grow around the harvested pieces of your own bone making it the strongest finished product.
Jan 18 2012 7:55PM
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skinakedfast
Posts: 1296 - Karma: 487
I went with the hamstring because it' suppossed to be actually stronger than your original ACL after good, serious rehab. I'm 2 weeks out of surgery and am about 9 degrees away from 0 for my extension and I have about 120 degrees of flexion. It was really painful the first 3 days and sleeping is just kinda annoying cause of how it should be flexed while over night. But generally see a couple surgeons and if you can see a sports surgeon and do the graft he is most comfortable with. They always have a back up cadavar if something is wrong or doesn't look right.
Jan 18 2012 7:57PM
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skier_07
Posts: 326 - Karma: 51
I have had both a patella and a hamstring graft done (on the same knee in less than a year). They both have their benefits and I would do whatever your surgeon thinks is best.

I will say the thing I hate about the patella graft is the scar right down the front of you knee that is painful to kneel on for a good long while. On the positive side I was told that this would actually grow back in.

Downside to the hamstring is the amount of rehab you have to do to get it back to where it needs to be.

I can't really give you the pluses and minuses through rehab because with my patella graft I had a staff infection that basically took all the elasticity out of the graft and had all the issues relating to that...
Jan 18 2012 10:47PM
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Lemuel
Posts: 14527 - Karma: 10,964
Patella graft.
Jan 18 2012 11:37PM
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DockEllis
Posts: 1131 - Karma: 1,745
i went with the cadaver about 4 years ago and its worked out great
Jan 19 2012 12:59AM
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loganimlach
Posts: 5132 - Karma: 14,054
i did patella and have had tendonitis in my knee ever since. worst decision i ever made, not a day goes by that my knee isn't sore.
Jan 19 2012 5:31AM
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razors-chaz
Posts: 2255 - Karma: 1,250
What ever you do go with rehab like its your job
Jan 19 2012 6:39AM
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reBlocke
Posts: 762 - Karma: 1,502
Your surgeon is most likely going to be comfortable in one or the other - so you might not get to choose. However, if you have the option of choosing surgeons- Patella grafts predispose you to tendonitis, which is something to consider if you've had Jumper's Knee or are a big runner. They also have a larger scar if you happen to be a model. Hamstring grafts often take a little longer to rehab because of the weakness in your hamstring.

All that said, a much larger determinant of how well it goes is going to be how experienced the surgeon is and how intensely you rehab. I had a hamstring graft and have never had any issues.
Jan 19 2012 8:56AM
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bpalmer
Posts: 2408 - Karma: 93
aren't you a model bri?
Jan 19 2012 9:16AM
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crawley
Posts: 605 - Karma: 729
Man I'm sorry to hear that Logan. I did patella and mine is 100% or more, I trust it more than my "good" knee. In the NFL the patella is the only reasonable choice because it is simply (statistically speaking) the most reliable choice. Over 80% of NFL players use the patella, so I think that stat pretty much speaks for itself and ends the argument as far as I'm concerned. That said- NS is not a bunch of doctors. You need to talk to multiple doctors and make a decision based on your body and your injury, and your doctors expertise. The quality of the rest of your life with your knee depends on doing this right, getting the right doc, and putting the work into the rehab that is necessary. Good luck!
Jan 19 2012 9:21AM
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Capurnicus
Posts: 9947 - Karma: 1,886
I had a hamstring graft last October and haven't had any issues. Sure my knee gets sore once and a while, but that's gonna happen no matter what route you go. My hamstring, however, has not ever been sore and it wasn't particulary painful after surgery either. I don't feel any weakness in my leg at all and my doc told me hamstring grafts are the strongest option, said that's what NFL dudes go for, so I'm quite happy with it. I've had friends go with cadaver and also be quite satisfied, but it seems like everyone I talk to who has had the patella graft complains about pain. The only downside to a Hamstring graft is that you can only do it once.
Jan 19 2012 10:20AM
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crawley
Posts: 605 - Karma: 729
You can only use your patella once also. The reason NFL guys don't use hamstring is because it does not regenerate and they need every ounce of hamstring they can get. The patella does regenerate but often causes tendonitis and is the most difficult to rehab. Not an easy choice and every person is different, again, talk to several docs and figure it out.

In 2008 This is the breakdown of ACL repair procedures on NFL players.
– BTB Patellar autograft 84%
– Hamstring autograft 6%
– Achilles allograft (cadaver) 10%

Source: http://www.whcenter.org/workfiles/cmeprograms/acl_recon_nfl.pdf
Jan 19 2012 10:30AM
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garygohard
Posts: 1463 - Karma: 2,871
cut your legs off.
Jan 19 2012 11:05AM
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richard.
Posts: 873 - Karma: 55
heard this too about the hamstring being the strongest. Although (I think) recovery may take a bit longer.
Jan 19 2012 11:23AM
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mizzike
Posts: 1386 - Karma: 251
I did a hamstring graft in April of 2009 and I would recommend it. Having some dead guys body part in my body was not too appealing to me. I do think my rehab took a bit longer the the average 6 months because of it though. Usually it's best to listen to your doctor's recommendation on these kinds of things, so if I were you I would discuss it with him/her.
Jan 19 2012 11:36AM
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Capurnicus
Posts: 9947 - Karma: 1,886
Oh dang, I have no doubt my doc was totally BSing when he said that then, doesn't really surprise me.
Jan 19 2012 2:26PM
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crawley
Posts: 605 - Karma: 729
haha, I totally agree there is a lot of bs floating when it comes to ACL repair, I think a lot comes from what the doc is comfortable doing. Harvesting a patella and harvesting a hamstring are very different procedures, and it's logical to expect a doc who is very good at one procedure to recommend that route. Hell it would be insane to ask him to exit his comfort region anyways. That's why I always tell people to see tons of doctors if they can. Hamstring, patella, double bundle, cadaver, the docs these days have gotten so damn good that your chances with any one of them are extremely high.

See docs, have them evaluate you in person (not over the internet), figure out what will work best for you in rehab and then kill the rehab and you'll be back to 100% in no time.
Jan 19 2012 2:50PM
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Geonerd
Posts: 251 - Karma: 64
I did hamstring and was skiing in 5 months no prob.

Hamstring is the strongest and with fastest recoveri (6 month), dead tissue recovery is about a year to be skiing and your body may reject, but you do not have to recover your hamstrings which is a little bit boring.

I would go for hamstring if you want fast and strong recovery.
Jan 21 2012 8:17AM
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Mrvic.
Posts: 1033 - Karma: 154
going with patella thanks for the input
Jan 21 2012 1:29PM
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