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Cadaver, Patella or Hamstring?

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theBearJew
Posts: 10951 - Karma: 15,633
I'm about to do my surgery for my ACL and wanted to hear some experiences from people who have gotten them? What have you experienced from them?

From what I have heard the cadaver has a 20% failure chance for young people because the body rejects the foreign tissue. Patella causes problems in the knee like kneeling and some permanent numbness, and the hamstring might make your hamstring weaker and the ACL might be weaker than a cadaver or patella.


My doc suggested taking some of the hamstring and a cadaver to combine them giving a strong ACL with the combination. And using my own tissue from the hamstring will not cause it to reject it.


What are your experiences?
Jan 16 2014 3:01PM
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theBearJew
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Also wondering what recovery is like or if it is at all different.
Jan 17 2014 10:50AM
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Darth.Maul
Posts: 2472 - Karma: 652
My buddy tore his ACL and partially tore his Meniscus and got a new ACL from a cadaver. He was in bed for about 4-5 days and had to use a wheel chair for about 2 weeks. Then it was crutches.
Jan 17 2014 10:53AM
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Ski_Alot
Posts: 5890 - Karma: 3,584
You don't feel at all weird getting a piece of a dead person in you?
Jan 17 2014 10:53AM
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theBearJew
Posts: 10951 - Karma: 15,633
Not at all. What are organ donors for?
Jan 17 2014 10:56AM
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prometheusprime
Posts: 735 - Karma: 677
I had a cadaver and haven't had a single complication or issue. You're young, your body is resilient and it will accept the cadaver and heal. The only advice I have for you is to make sure you get the best surgeon you possibly can, do some research and find the best doctor possible. The quality of the surgery will ABSOLUTELY make a difference in your recovery.
Jan 17 2014 11:12AM
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DockEllis
Posts: 1131 - Karma: 1,745
It kinda weirded me out at first when I thought about it. But no, not at all really.

I tore mine in 08 and went with the cadaver. Surgery wasn't too painful. Never was bed ridden or in a wheel chair. Had 1 to 2 weeks of no weight on the leg using crutches, and then crutches with a little weight for a 1 or 2 weeks and then was walking fine without crutches and wearing a knee brace. I was cleared for everything for almost a year if I remember correctly.

It really wasn't that bad, by far the worst part is when you're knee feels great towards the end of your rehab but you still aren't cleared to ski or run. Rehab as hard as you can, it will pay off big time. Good luck man.
Jan 17 2014 11:16AM
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FunkyButtLoving
Posts: 60 - Karma: 14
I had ACL surgery the summer of 2010. Also had a torn meniscus but I went with the hamstring. Overall I have had no complaints but the process of recovery was definitely a long one. And using your hamstring does require more rehab than using the cadaver. The most important thing for me was being vigilant about doing the rehab and going to the sessions even though it was tough and painful. And making sure that you don't try anything crazy once you start feeling better because your body still needs to heal and what not. Just be patient and good luck man.
Jan 17 2014 11:28AM
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theBearJew
Posts: 10951 - Karma: 15,633
Has anyone else ever heard of this combination with the hamstring and a cadaver that my doc is talking about? I am not trying to be a guinea pig for a new surgical procedure idea hes got. He did say he used it on a NFL WR a few years back and hes doing great. But idk... I guess he takes less of the hamstring than normal and combines it with a cadaver.
Jan 17 2014 11:37AM
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Caucasian_Asian
Posts: 2447 - Karma: 1,665
After I tore my ACL, I had a hamstring graft done.  Surgery took place on a Friday morning.  Discharged that afternoon, hobbled around on crutches for the weekend.  First day of PT was on the Tuesday.  Walked on crutches for a week.  Limped with a knee brace for a week afterwards.  Walked fine after that, still with a brace on.  I did 10hrs of PT a week for the next six months.  At my six month checkup with the surgeon, I was given the green light to ski.  I skied the next day.  I still ski with my brace on, but I no longer wear it daily.


I also did a lot of strength and balance exercises to build up the muscles before my surgery.  I feel that helped speed my recovery. 
Jan 17 2014 11:56AM
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90053
Posts: 2565 - Karma: 3,728
in the uk at least i think the hamstring graft is used for the majority of cases, had mine done about a month ago and couldn't be happier. never heard of the hamstring cadaver combo before

listen to your doctor, they recommend the right option on a case by case basis
Jan 17 2014 12:11PM
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90053
Posts: 2565 - Karma: 3,728
also in terms of the hamstring being weakened i dont think it is hugely significant as i had a grade 2 hamstring tear just over 2 months before the surgery

Jan 17 2014 12:55PM
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SKI.ING
Posts: 2695 - Karma: 2,535
I'm speaking from the hip, and have no experience here. But the combo thing seems odd as they are still going to surgically require some hamstring but then still use the cadaver tissue. I'd rather do the least invasive procedure possible and that seems like the most invasive.
Jan 17 2014 1:50PM
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the.hellion.
Posts: 861 - Karma: 698
I had 2 patella grafts, one per leg. I like the bone to bone graft and all my natural tissue. Healed up really well, but the trick to surgery is the rehab,
Pre and post op. I managed to have both surgeries within 3 months of each other, that means my first had to heal up well enough to support the second, it all went really well. There is still some numbness but, whatever, I really don't need to feel the small scar area on my knee anyway. 3 years out almost no pain kneeling, though this did linger, again - I'm not on my knees much so, no problem. All I can say is rehab, get that muscle mass back, get them firing again and make sure you stretch out your hamstrings.
Jan 17 2014 1:55PM
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theBearJew
Posts: 10951 - Karma: 15,633
I spoke with the physicians assistant today and she said that the "hybrid" as he is calling it he uses to not take as much from the hamstring and if needed adds a cadaver to your own hamstring to make it a really strong graft. I did a lot of searching and couldn't find this method anywhere and he is the only one in his office who does this.

That all being said it doesn't mean its a bad thing. I think this guy is the best down here and I trust this method. Gonna go with it and will post to back later hopefully good results.

Surgery is scheduled for the 24th of Feb cause he will be out for 2 weeks on vaca.
Jan 17 2014 4:53PM
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DR.SHRED
Posts: 2134 - Karma: 503
i went cadaver route with a surgon that is well known and worked with the unr teams for 10 years. i was on crutches for about a week then i could walk after that. i re tore it recently and gonna do another cadaver. i re tore it on a tramp and my legs were pretty weak at the time so i dont think it had any thing to do with the cadaver because i was skiing on it hard for 2 seasons with NO issues
Jan 17 2014 5:37PM
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ChillTeenDad420
Posts: 1858 - Karma: 5,512
studies suggest that autographs heal more quickly and are accepted more readily by the body, so if you don't mind having a bit of numbness in the front of your knee for a few years, i'd go with the patella, of if you'd rather rehab your hamstring, then go for that option. thats what I got, and apparently it has the lowest retear rate for young athletes under like 25. cadaver grafts tend to take longer to gain a blood supply and turn into a ligament, so they won't be as strong as quick.
Jan 18 2014 12:50AM
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ChillTeenDad420
Posts: 1858 - Karma: 5,512
^i got the patellar, that is
Jan 18 2014 1:05AM
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~bagelz~
Posts: 1105 - Karma: 1,067
im going in for acl reconstruction in a couple weeks and im doing the hamstring method. you already have 4 hamstrings per leg so the doc told me only sprinters truly notice a difference and thats just because they dont kick their butt anymore. the technology they have nowadays is amazing tho the screws they use to fill the holes are made of calcium and lactic acid so the acid gets absorbed and the calcium becomes bone.
fortunately the doc who's doing mine is super experienced and was the us ski team physician for a couple years.
Jan 18 2014 1:20AM
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Download-My-Apps
Posts: 5069 - Karma: 1,017
Honestly, you want what ever your surgeon is most comfortable doing as a procedure. That will dictate the best quality.
Jan 18 2014 2:18AM
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arnie_grape
Posts: 3451 - Karma: 11,678
what the fuck? I had both sides meniscus repair and ACL redone and I was walking on crutches from day 1

and I got patella graft, my surgeon said it would take longer to graft than hamstring but it could potentially hold up better under impact so it'd be better for skiing
Jan 18 2014 7:50PM
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Download-My-Apps
Posts: 5069 - Karma: 1,017
One thing I;ve always wondered was if using the hamstring would making you more likely to re-tear your acl skiing, as weak hamstrings is often a cause
Jan 18 2014 10:12PM
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B.Aussie
Posts: 5852 - Karma: 4,531
I had hamstring done and so did everyone I know on the Australian team. It's the more commonly done one here. We also have one called LARS that is I think plastic and only has a 3 month recovery.

Personally I did see any extra any hamstring weakness once I was at the stage I had no weakness in my other leg. 2 years later and every muscle including the hamstring are still stronger than my other leg.
Jan 18 2014 10:53PM
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Anathema
Posts: 21048 - Karma: 5,061
most people get hamstring. its pretty easy to do, you dont have any lasting deficits.

patellar is probably the best to get as it allows the quickest recovery (despite having an awful time getting your range of motion back early on) since you wont have the problems with the hamstring that result from the hamstring graft.

an allograph is pretty rare as your body can sometimes reject foreign tissue and you can have complications with the recovery, but obviously there are no real deficits from taking a piece of your own tissue (and of course if you are for some reason unable to, then there might not be a choice)

but overall, surgeons try to do autografts with the patellar tendon on athletes and hamstrings any other time.
Jan 18 2014 10:58PM
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Lemuel
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Patellar is the strongest (so I've been told). I couldn't kneel for about 2 years and most of the numbness went away by then. Feels pretty funky for a while though.

Second time I went cadaver because I couldn't use patellar again without grafting from the other knee and my doc isn't a fan of hamstring. So my knee is a little numb again but not terrible. Cadaver is a much quicker recovery off the bat, got to 90 degrees within a few days where as the patellar takes a long long time to get full ROM back.

I'm also thinking at this point that I should have grafted my patellar from my other knee, but that brought up issues of what to do if / when I blow out the other knee.
Jan 18 2014 11:35PM
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Lemuel
Posts: 14486 - Karma: 10,624
I had my meniscus and ACL redone and I couldn't weight bear for 4 weeks. They don't want you putting any pressure on the meniscus, that way it can heal properly.
Jan 18 2014 11:59PM
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Anathema
Posts: 21048 - Karma: 5,061
depends on what you do to your meniscus. under most circumstances you should NEVER be zero weight bearing following surgery. it's almost always partial as tolerated. there were maybe one or two cases that i've seen where people have had zero weight bearing following a very serious repair, but most meniscal surgeries are menisectomies, where they just take a piece out and you're pretty much full weight bearing and biking from day one.

sometimes doctors take the hyper cautious route and it does nobody any favors. the majority of my current patient load is ACL repairs and the first thing i do with them following surgery is get them to stand on on two legs, weight transfer as tolerated, and get the joint flexing and extending.

but any way, a little off topic. if you have an option, get the patellar. youll have a nice quick recovery after that painful, awful 6 weeks of getting your knee moving again (because as you would expect when you bend your knee it just rips away at your patellar tendon where you have all that scar tissue).
Jan 19 2014 7:50PM
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J.D.
Posts: 21362 - Karma: 5,142
Hammy for this guy. Still sore a year later when I try to fully extend, but it feels strong.
Jan 19 2014 7:52PM
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Edward.
Posts: 9366 - Karma: 445
All I know is the surgeon who did my 2 patellar grafts strongly advises against cadaver grafts in young & active people (young being under about 30 yrs old or so)
Jan 19 2014 8:51PM
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acc
Posts: 4122 - Karma: 222
I had patella on my right knee 12 years ago and it's strong and stable
I had hamstring on my left knee 8 years ago and it's a bitch
Jan 19 2014 9:29PM
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theBearJew
Posts: 10951 - Karma: 15,633
Care to elaborate on what "bitch" means?
Jan 19 2014 10:01PM
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Darth.Maul
Posts: 2472 - Karma: 652
I dunno thats what I just remember. He completely smashed his meniscus and his bones grinded together.

The pics of his cadaver acl were pretty sweet though since its purple.
Jan 19 2014 10:20PM
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seemeski
Posts: 4210 - Karma: 124
I had cadaver and hamstring for my ACL five years ago. All I've heard from people is petella is the way to go, much less invasive than hamstring. I have a numb spot on my shin and my hamstring doesn't feel the same (my fault for not keeping up with PT) just do your therapy and keep strong and you'll be good.
Jan 20 2014 3:14AM
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