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ACL Research Quad vs Hamstring Data Collection

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d-halla
Posts: 15 - Karma: 107
Hi all,

I'm doing some research and collecting data on quad vs hamstring. Predominantly, skiers seem to have gotten hamstring grafts. In the past 5 years, doctors seem to be gravitating toward Quad for lower retear rates, but I'm finding hard to find instances of skiers with quad reconstructions. I'm wondering why (quad muscle is too valuable for skiers to mess with?, low sample size since quad started being used?, geographically doctor preference? (colorado vs utah vs tahoe)


Wondering if you know any skiers (regular people or pro) who tore their ACL, and if possible the graft they had. thx

**This thread was edited on Jul 15th 2022 at 1:31:32pm
Jul 15 2022 1:31PM
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danbrown
Posts: 11939 - Karma: 21,833
I had hamstring in 2017. my surgeon was andrew cooper, head US ski team doc, salt lake city
Jul 15 2022 1:39PM
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d-halla
Posts: 15 - Karma: 107
The referenced post has been removed.


How's the outcome? Donor site morbidity?

I imagine successful, and low
Jul 15 2022 1:39PM
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danbrown
Posts: 11939 - Karma: 21,833
d-hallaHow's the outcome? Donor site morbidity?

I imagine successful, and low


not sure what happened there but outcome was totally fine, hamstring and knee are both great, minimal scarring, knee is good as new. hamstring was definitely sore after surgery but it was a complete non issue after a week
Jul 15 2022 1:45PM
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d-halla
Posts: 15 - Karma: 107
danbrownnot sure what happened there but outcome was totally fine, hamstring and knee are both great, minimal scarring, knee is good as new. hamstring was definitely sore after surgery but it was a complete non issue after a week


Awesome thanks for your input. Glad to hear life is good
Jul 15 2022 1:51PM
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ReturnToMonkey
Posts: 6427 - Karma: 69,843
Is it too soon for good data if I had my quad tendon graft done about 6 months ago? Done in Bozeman, MT
Jul 15 2022 1:54PM
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d-halla
Posts: 15 - Karma: 107
ReturnToMonkeyIs it too soon for good data if I had my quad tendon graft done about 6 months ago? Done in Bozeman, MT


Nope! I'll take it. MT seems to be geographically quad - a Flathead Valley surgeon does mostly quad, and people I know seem to have good success. How's rehab going?

**This post was edited on Jul 15th 2022 at 1:58:01pm

**This post was edited on Jul 15th 2022 at 2:02:15pm
Jul 15 2022 1:57PM
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ReturnToMonkey
Posts: 6427 - Karma: 69,843
d-hallaNope! I'll take it. MT seems to be geographically quad - a Flathead Valley surgeon does mostly quad, and people I know seem to have good success. How's rehab going?

It was going really well until my insurance stopped paying for my PT sessions. I bike a ton but I havent been working out quite enough since then due to no good gym access. My quad definitely hurt a lot for the first couple weeks but is mostly pain free now. When I drink alcohol there is some pain in the muscle. Certain weather conditions I can feel my knee joint is a little more sore. Otherwise it has expected strength, full range of motion, and no issues.
Jul 15 2022 3:51PM
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BradFiAusNzCoCa
Posts: 7134 - Karma: 62,655
I had, what I think was, a partial Quadriceps tendon tear in my left knee. Still acts up some but is okay if I strengthen muscles around it. Alcohol can flair it up too
ReturnToMonkeyIt was going really well until my insurance stopped paying for my PT sessions. I bike a ton but I havent been working out quite enough since then due to no good gym access. My quad definitely hurt a lot for the first couple weeks but is mostly pain free now. When I drink alcohol there is some pain in the muscle. Certain weather conditions I can feel my knee joint is a little more sore. Otherwise it has expected strength, full range of motion, and no issues.
Jul 15 2022 6:04PM
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FaunaSkis
Posts: 611 - Karma: 6,611
I got a patellar tendon graft after just straight up asking my sugeon to do it an hour before surgery. He had planned a hamstring. Does this make me core?

recovery has been good

most of my friends who had surgery had a hamstring graft. I’ve not heard of any getting a quad graft. Some had an allograft.
Jul 15 2022 6:39PM
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Rparr
Posts: 5627 - Karma: 46,830
ReturnToMonkeyWhen I drink alcohol there is some pain in the muscle

This is very interesting to me, I had no idea this was a thing
Jul 15 2022 7:41PM
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ReturnToMonkey
Posts: 6427 - Karma: 69,843
RparrThis is very interesting to me, I had no idea this was a thing

Alcohol affects your nervous system and muscular system. I've always felt a little extra pain in my muscles when working out after a heavy night of drinking, but now I can feel exactly where they cut into my tissue just from one drink and a little walking. It's not bad, just interesting
Jul 15 2022 8:57PM
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eheath
Posts: 61703 - Karma: 124,137
I had a patella graph in 2005, I had a fast recovery at my age (16) and my knee feels fine now.
Jul 15 2022 11:01PM
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Twig
Posts: 6430 - Karma: 60,415
Hamstring graft, January 2021, so far so good. No donor site issues to note.
Jul 16 2022 8:03AM
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d-halla
Posts: 15 - Karma: 107
TwigHamstring graft, January 2021, so far so good. No donor site issues to note.


I actually read your blog posts. They were great. Thanks!
Jul 16 2022 1:00PM
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3mania
Posts: 2618 - Karma: 10,437
I had a patellar replacement way back in '93. I don't really remember being given much of a choice, but I have really thick chunky patellar tendons so i think it was the right choice. I still have a very defined space on my tendon where the cut out the graft, but i never really dealt with any tendonitis or pain. Rehabbed pretty hard, worn a brace for the next winter and never really had any issues, until 98 or 99.
Went in had a little clean up, cut out some tattered pieces of meniscus, scrapped out some scar tissue off the back of my knee cap. i stayed awake and watched on a screen above the table. Way cool, you could see the tiny little scissors cutting off the torn pieces of meniscus and the doctor used a flat scraper to get the stuff off the back of my kneecap. It looked like stalagmites hanging off a cave roof. After that i've been 100% for the last 22 years.
Anyhow I'm glad i had a patellar replacement, it's the closest tendon (location) to your ACL and if you got thick enough ones, i think it works best.
Jul 16 2022 2:08PM
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Dlonetti
Posts: 1883 - Karma: 19,669
Patellar graft gang two winters ago. Healed really well, slight difference in leg muscles still, left quad still a little smaller than the other
Jul 17 2022 11:04AM
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SkierPT
Posts: 2205 - Karma: 4,858
From what I've seen from my practice as an orthopedic physio, graft choice seems to be mostly dependent on the surgeon. I would assume there also may be some geographical biases as well. I know that quad tendon is what is gaining the most traction from better outcomes, but not every surgeon was/ is trained for that surgery type.

Non-operative ACL rehab is also gaining a lot of steam with plenty of good research coming out showing the ACL can heal in some cases (without surgery). I haven't seen any papers about skiers and this option though. It's my professional opinion that we are not a great population choice for non-operative routes due to the demands we place on our knees.

Feel free to DM me with anymore questions.
Jul 17 2022 9:35PM
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oldmanski
Posts: 3365 - Karma: 24,376
Hamstring left knee 1997 in Pocatello,ID at Idaho State University sports medicine. Back to 100% with no issues as of now.
Hamstring right knee 2019 in Vancouver, WA at Rebound Orthopedics. Back to 100%with no issues. I chose hamstring since the first one worked. Good luck with your research.
Jul 18 2022 8:12AM
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Thegenericskier
Posts: 2649 - Karma: 30,286
2 years ago I shredded mine and got it replaced with my quad
Jul 18 2022 12:55PM
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CT_CREW
Posts: 671 - Karma: 3,526
got a hamstring graft, didnt heal up well, the "hole" where the tendon attaches to the bottom of femur got widened out, and acl was all loose. MY hamstring still doesnt have full range of motion on that leg many years later. Got all that fixed with a bone graft, and then patellar tendon graft, which healed up much better.
Jul 19 2022 9:51AM
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paige.
Posts: 1932 - Karma: 926
SkierPTNon-operative ACL rehab is also gaining a lot of steam with plenty of good research coming out showing the ACL can heal in some cases (without surgery). I haven't seen any papers about skiers and this option though. It's my professional opinion that we are not a great population choice for non-operative routes due to the demands we place on our knees.

My dad fit into this category. Physio had a suspicion the ACL was gone and the MRI eventually confirmed it, but his knee stability was so good they made the decision not to reattach - he was already back running, skiing and whatever with just a brace by that point. He did go in for a smaller surgery just to clean up the meniscus and loose tissue, at which point the surgeon apparently told him he made the right choice as the ACL had somehow started healing itself.

He continued skiing hard for another 10 - 12 years without issue, although he never gave up the knee brace.
Jul 19 2022 5:49PM
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d-halla
Posts: 15 - Karma: 107
CT_CREWgot a hamstring graft, didnt heal up well, the "hole" where the tendon attaches to the bottom of femur got widened out, and acl was all loose. MY hamstring still doesnt have full range of motion on that leg many years later. Got all that fixed with a bone graft, and then patellar tendon graft, which healed up much better.


Woof. That's a tough road.
Jul 20 2022 12:55PM
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hollydayszn
Posts: 5 - Karma: 54
I came here to say that the future is here and a completely torn ACL does not need to be reconstructed with a graft to heal. There is a surgery that uses a mesh bridge made out of collagen covered in the patients blood and is sewn on the torn ends of the ACL. Over 8 weeks the ACL grows back together using the bridge and the bridge dissolves. It is called the BEAR implant. Bridge enhanced ACL repair. I got this surgery mid-may and I have had an extraordinary recovery so far. I’ll be making a post about it in Newschoolers soon!
Jul 21 2022 5:14PM
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Dlonetti
Posts: 1883 - Karma: 19,669
hollydaysznI came here to say that the future is here and a completely torn ACL does not need to be reconstructed with a graft to heal. There is a surgery that uses a mesh bridge made out of collagen covered in the patients blood and is sewn on the torn ends of the ACL. Over 8 weeks the ACL grows back together using the bridge and the bridge dissolves. It is called the BEAR implant. Bridge enhanced ACL repair. I got this surgery mid-may and I have had an extraordinary recovery so far. I’ll be making a post about it in Newschoolers soon!


Whats the recovery time frame for this?
Jul 22 2022 9:36AM
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d-halla
Posts: 15 - Karma: 107
Thanks for all your input so far. I'll post my data collection soon.

I've heard about the Bovine BEAR implant, but conflated it with pure stem cell and PRP treatment (my dad had a Regenexx stemcell treatment in his knee to buy some time before a knee replacement). When I first tore my ACL I thought it was partial and was looking at these options.

Am interested in the BEAR writeup when you post it. I guess I'm curious about long term data as this was clinical 4 years ago. I was talking with a UT doc, and he said implants in the 80s and 90s were great until they broke (they were made of goretex, haha). Just wondering how long it's effective.

I also imagine time to sports is longer. It sounds like the implant is consumed in 2 months, but light activity and no sports for 9 months. You probably have to be super religious about combating the "I feel great, I can go do X" mentality. Correct?
Jul 22 2022 11:39AM
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hollydayszn
Posts: 5 - Karma: 54
d-hallaThanks for all your input so far. I'll post my data collection soon.

I've heard about the Bovine BEAR implant, but conflated it with pure stem cell and PRP treatment (my dad had a Regenexx stemcell treatment in his knee to buy some time before a knee replacement). When I first tore my ACL I thought it was partial and was looking at these options.

Am interested in the BEAR writeup when you post it. I guess I'm curious about long term data as this was clinical 4 years ago. I was talking with a UT doc, and he said implants in the 80s and 90s were great until they broke (they were made of goretex, haha). Just wondering how long it's effective.

I also imagine time to sports is longer. It sounds like the implant is consumed in 2 months, but light activity and no sports for 9 months. You probably have to be super religious about combating the "I feel great, I can go do X" mentality. Correct?


The BEAR implant dissolves over 8 weeks and it is replaced with your healed ACL. It has not failed. :)
Jul 22 2022 3:48PM
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hollydayszn
Posts: 5 - Karma: 54
hollydaysznThe BEAR implant dissolves over 8 weeks and it is replaced with your healed ACL. It has not failed. :)


It is about a 7-9 month recovery which is very similar to the ACL reconstruction recovery time. This is because of muscle atrophy around the knee.
Jul 22 2022 3:56PM
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d-halla
Posts: 15 - Karma: 107
Assuming it will come in the blog post, but how does it get tensioning right? And is there window of ideal time (sooner to injury date)?
Jul 22 2022 4:16PM
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snomaster
Posts: 3346 - Karma: 5,776
hamstring graft ACL reconstruction in 2004.
all good. but the rest of my body...
Jul 23 2022 1:03AM
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CT_CREW
Posts: 671 - Karma: 3,526
d-hallaWoof. That's a tough road.


indeed, all worth it for that ski life we love..Also forgot to mention my LCL got fully blown due to a wreck with the loose ACL, got that fixed at the same time of second acl graft.

also on the topic of alternates to ACL graft surgery.... I was about 95% percent sure i blew out my other ACL this winter at A basin on march 1... at the very least a full tear of the MCL and sprain of ACL. I was tired of surgeries and doctors so I never got it checked out. didnt do any intense physical activity from then untill mid June when it started to feel more stable. now im skateboarding with full confidence this summer and got high hopes for the winter. Might go in to the docs to get it tugged on to see if I actually still have an ACL before then. Ill check back in.
Jul 25 2022 10:36AM
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mikemac
Posts: 1297 - Karma: 3,710
Tore my ACL and had a hamstring graft done in the boston area in 2009/2010. Bounced back no problem and was playing football and skiing next fall/winter.

retore that same ACL almost ten years later in 2021, got a quad graft this time in jackson wy

A. Because they had already harvested my hamstring and couldn’t do another from the scarred region

B. My surgeon doctor Bullington of Teton orthopedics (somebody who does hundreds of knees a year like literally dozens a day) said that it’s kind of the new hotness with surgeons these days because data is in fact shower longer lasting grafts and less re-tears.

Honestly had a much tougher recovery on this one but can’t say it’s all from the graft…. More probably just from being almost 30 and trying to work on my feet full time too soon during recovery.

I had quite a bit of scarring on my quadriceps tendon where they harvested the graft from and had to have a minor manipulation/scar tissue removal procedure 9 months out. BUT a little over a year later from the replacement (5 - 6 months from the cleanup arthroscopy) I’m feeling pretty darn good again.

hopefully won’t be tearing it again anytime soon lol
Jul 26 2022 1:50AM
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d-halla
Posts: 15 - Karma: 107
CT_CREWindeed, all worth it for that ski life we love..Also forgot to mention my LCL got fully blown due to a wreck with the loose ACL, got that fixed at the same time of second acl graft.

also on the topic of alternates to ACL graft surgery.... I was about 95% percent sure i blew out my other ACL this winter at A basin on march 1... at the very least a full tear of the MCL and sprain of ACL. I was tired of surgeries and doctors so I never got it checked out. didnt do any intense physical activity from then untill mid June when it started to feel more stable. now im skateboarding with full confidence this summer and got high hopes for the winter. Might go in to the docs to get it tugged on to see if I actually still have an ACL before then. Ill check back in.


I had impact fractures and that was most of the pain and stiffness I had. I'm prehabbing pretty hard and life is quick normal - aside from quick pivot when playing spikeball haha
Jul 26 2022 10:53AM
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d-halla
Posts: 15 - Karma: 107
mikemacTore my ACL and had a hamstring graft done in the boston area in 2009/2010. Bounced back no problem and was playing football and skiing next fall/winter.

retore that same ACL almost ten years later in 2021, got a quad graft this time in jackson wy

A. Because they had already harvested my hamstring and couldn’t do another from the scarred region

B. My surgeon doctor Bullington of Teton orthopedics (somebody who does hundreds of knees a year like literally dozens a day) said that it’s kind of the new hotness with surgeons these days because data is in fact shower longer lasting grafts and less re-tears.

Honestly had a much tougher recovery on this one but can’t say it’s all from the graft…. More probably just from being almost 30 and trying to work on my feet full time too soon during recovery.

I had quite a bit of scarring on my quadriceps tendon where they harvested the graft from and had to have a minor manipulation/scar tissue removal procedure 9 months out. BUT a little over a year later from the replacement (5 - 6 months from the cleanup arthroscopy) I’m feeling pretty darn good again.

hopefully won’t be tearing it again anytime soon lol


This is great. Thanks for your story/insight. Do you know if Bullington is doing more hamstrings vs quad? My doc is still going for hamstring and surgery technique. His philosophy is to stay away from the extensor if you can. But, quad sounds like a really good thing going though.



I have a nurse friend and she's having a real tough time getting time in for rehab, additional schooling, and clinical. She's in the same boat - on her feet all day and recovery is tougher.
Jul 26 2022 10:59AM
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d-halla
Posts: 15 - Karma: 107
Here's the first pass results for those interested. Data is from public online sources (interviews, pictures, and this forum). I've got some work to do, but you all have been a big help.
Jul 26 2022 11:59AM
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mikemac
Posts: 1297 - Karma: 3,710
d-hallaThis is great. Thanks for your story/insight. Do you know if Bullington is doing more hamstrings vs quad? My doc is still going for hamstring and surgery technique. His philosophy is to stay away from the extensor if you can. But, quad sounds like a really good thing going though.



I have a nurse friend and she's having a real tough time getting time in for rehab, additional schooling, and clinical. She's in the same boat - on her feet all day and recovery is tougher.


Sounded to me like the quadriceps graft was his preferred method these days and that he was recommending it to all patients mainly due to the strength of the graft and lower risk of re-tear.

He did say that the scarring in the “pouch” where he harvested the graft from is common and can often necessitate a manipulation like I had.

That being said, the reconstruction and manipulation were my 3rd and 4th surgeries on my left knee (also had my meniscus scoped in 2017 after a tibial plateau and femoral condile fracture). After all that trauma my slower recovery is to be expected…. But also like I said was managing a hotel restaurant 6am-midnight 7 days a week last summer which certainly didn’t help.

Despite it all I’m really only a year and three months out from the reconstruction in 2021 and really starting to feel good again on the mountain bike and In the weight room. Pretty much right on track for a 1.5 year full recovery - I’d say typical for a hyperactive 30 yr old with a history of knee issues
Jul 26 2022 7:39PM
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ModMommy
Posts: 10840 - Karma: 57,641
Hamstring, Missoula, MT, ended up with a cyclops lesion.
Jul 26 2022 7:41PM
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jca
Posts: 4172 - Karma: 6,310
Located in British Columbia
Blew my 1st ACL (left) along with a torn MCL in 2011, had it fixed in Trail, BC with a hamstring graft ~2 months later. That graft failed at some point in the first year but I didn't notice.
Then I blew my right ACL and tore my meniscus in 2013. It took so long to have an MRI and to see a surgeon this time that I had rehabbed to around 95% so decided to keep them as strong as possible and wait.

Fast forward to last year, I'd had a few tweaks from new meniscus tears so after talking to some physios and Drs I decided to get them fixed up.
I had both ACLs and menisci repaired this summer by a surgeon from Banff Sport Medicine. First my right knee with a hamstring graft, and second the left knee with a patella graft. The surgeon also used some IT band to make an extra lateral ligament in each knee for even more stability.

So far so good but we'll see how she goes!
Jul 28 2022 2:28PM
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CT_CREW
Posts: 671 - Karma: 3,526
jcaLocated in British Columbia
Blew my 1st ACL (left) along with a torn MCL in 2011, had it fixed in Trail, BC with a hamstring graft ~2 months later. That graft failed at some point in the first year but I didn't notice.
Then I blew my right ACL and tore my meniscus in 2013. It took so long to have an MRI and to see a surgeon this time that I had rehabbed to around 95% so decided to keep them as strong as possible and wait.

Fast forward to last year, I'd had a few tweaks from new meniscus tears so after talking to some physios and Drs I decided to get them fixed up.
I had both ACLs and menisci repaired this summer by a surgeon from Banff Sport Medicine. First my right knee with a hamstring graft, and second the left knee with a patella graft. The surgeon also used some IT band to make an extra lateral ligament in each knee for even more stability.

So far so good but we'll see how she goes!


good luck my friend, hit that rehab hard
Jul 29 2022 10:57AM
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poonis
Posts: 255 - Karma: 1,455
From Denver area, I tore my ACL last December, had quad graft done at the end of January. Rn I'm just over 6 months into recovery, and everything is going great aside from some crunching and popping in that knee, but it's not painful anymore and I imagine it's just scar tissue. However, I did go for my first run since surgery last Monday, felt great so on Tuesday I went a little farther and faster, but I think I pushed myself a bit too hard and it's been pretty sore for the past few days but no swelling or stiffness. Probably just gonna not run again for a while and focus on rebuilding strength. It's probably nothing to worry about but of course I'm nervous because I don't want to jeopardize anything and push my ski season back.
Jul 31 2022 12:31PM
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Lemuel
Posts: 14508 - Karma: 10,781
Patellar graft in 2010, followed by a donor in 2013 when I blew that up. Been fine since.

tbh, I probably would have re-tore it no matter what the first graft was.
Aug 1 2022 5:52AM
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d-halla
Posts: 15 - Karma: 107
safarisamHamstring, Missoula, MT, ended up with a cyclops lesion.


Do you rec and PT's in MSLA? Might end up there for part of it
Aug 30 2022 10:35AM
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ModMommy
Posts: 10840 - Karma: 57,641
d-hallaDo you rec and PT's in MSLA? Might end up there for part of it


I live in Whitefish, so PT had been up here.
Aug 30 2022 11:39AM
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Kendall_sends
Posts: 2 - Karma: 17
Hey! Got my ACL done almost 5 months ago, I’m 14 and I used my quad, my surgeon and dr. Wahl, using ur quad is stronger in the end, it takes longer to heal but it lasts longer
Sep 24 2023 2:58AM
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emily.kennewell
Posts: 3 - Karma: 6
To gather specific data or anecdotes from skiers who have undergone ACL reconstruction, you may want to reach out to medical professionals, sports medicine experts, sports organizations, or companies that are doing B2B contact enrichment. Additionally, online forums or communities focused on skiing and ACL injuries may provide insights from skiers who have had these procedures and can share their experiences.

**This post was edited on Nov 9th 2023 at 9:11:48am
Nov 9 2023 9:10AM
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BagOTricks
Posts: 819 - Karma: 3,374
ACL blown in 2020, had quad graft per recommendation from my Doc. Nothing noticeable to me with my quad now, seems as strong as ever.

**This post was edited on Nov 9th 2023 at 9:49:25am
Nov 9 2023 9:48AM
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arnie_grape
Posts: 3455 - Karma: 11,739
ive had both my acls reconstructed and used patellar grafts for both.

it was explained to me by both surgeons that though it's a tougher and more painful recovery, patellar grafts are less susceptible to reinjury from impact.

been 10 years since my left knee and 4 years since my right knee. I forget that they ever happened.
Nov 10 2023 4:03PM
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porkch0p
Posts: 62 - Karma: 697
Had a patellar tendon graft in March 2020 as well as an anterolateral ligament (ALL) reconstruction with a cadaver hamstring to reduce chances of a re-tear. Recovery was super smooth and I had a full 2020/21 season. Felt super strong since, I'm more worried about my 'good' knee.
Nov 11 2023 11:01PM
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