Who here has busted their ACL?

I know everyone is different when it comes to repair and recovery, but I'm looking for thoughts post-surgery with your experience.

I tore my left ACL recently. I'm going to have it fixed. My options: patella tendon, hamstring or a cadaver.

I tore my right ACL 17 years ago and it was replaced with a patella tendon. Of course, I've experienced the annoying side affect of knee sensitivity to kneeling and feeling swollen. It's gotten better over time, but I don't really want to deal with the same thing in my left knee.

One day I think cadaver patella tendon, the next day I think hamstring. I've been talking to surgeons, outdoors folks, physical therapists, and reading sports medicine journals. Everyone has a different opinion.

My activities are primarily mountain rescue, backcountry skiing, backpacking and trail and road running.

Thoughts? Did you use hamstring or cadaver? How do you feel about the strength in your leg post-surgery? How was it getting back to your activity level?

Thanks!

right knee
tore it 16 years ago. used patellar tendon. 3 months back to "normal" 5 months back to real normal.
now tore right knee again. Had it replaced in early september with cadaver. Now at 3 months....

One thing different. I am 16 years older! 3 months and almost back to "normal" but I am more hesitant, and I believe more cautious and more protective.

I will have to say the cadaver is way better than the patellar tendon...way less invasive.

Done all 3. R-ACL 1988 Hammy, L-ACL-1995 Hammy; L-ACL-2007 Cadaver; L-ACL 2008 Patella.

By far, the cadaver graft was the least painful, no pain pills or crutches after ~day3, the one I did the most focused and extensive rehab for, the one my leg felt it's strongest with, and I received a clean slate to return to full activities at 6 months.

It's also the only one I had fail in less than a year (at 8 mos post op, ~day 20 skiing, again) and the one that really may take a full 9-12 months- depending on how well your body responds- for the scaffold graft to recover and be back to normal. A quality autograft either patella, or hammy, has a timeline more on the 6-9 months to full return.

In hindsight, I wish I had either gone with the patella graft to begin with or had the patience to not ski for a season. Up until the allograft failure I had never damaged the meniscus, and I really miss that padding.

I had my right ACL replaced using the patellar. I kept a blog of the progress along the way for others who may want to compare. One thing I learned along the way is the recovery procedures followed by doctors are night and day different from one to the other. Some want you in braces, others no braces. Some want you walking shortly after and others not for weeks. I've had friends who used hamstring and they seem to have suffered much more pain then I did, which is why I am very glad to have gone with the patellar. I've heard cadaver is a faster recovery, but I've also heard they may not be as strong, or could stretch? Just rumors I've heard since I have not had one first hand.

jacksacl.blogspot.com/
(it reads bottom up)

Good luck with whatever you choose. I had mine done in Issaquah at the Proliance center.

I've had two of the three. 1989 left knee patellar. 1996 right knee cadaver.

The patellar definitely had more pain immediately following surgery. The thing that annoyed me most was sensitivity while kneeling. After a year the knee was totally back to normal and stronger than ever.

The cadaver knee (aka my evil knee) didn't result in any kneeling pain. That said, I'm not sure it recovered any faster. Also, I didn't get nearly as cool of a scar from the procedure. Strength wise it was also back to normal after a year.

I'll probably get crap for this, but after I blew out the second knee I switched from skiing to snowboarding to reduce the stress on my knees. I joked that I was going to snowboard until I destroyed both shoulders or wrists from snowboarding. I wrecked my right shoulder (3rd degree separation) in 2008. Haven't gotten that fixed yet (shoulders are still an unsolved problem to some extent).

When I finally destroy my left wrist or shoulder I'll switch back to skiing I suppose.

I was told by my surgeon that the cadaver replacement would heal back stronger than the original ligament if all goes well as the replacement that grows over the lattice is slightly thicker than the original. I got the surgery in the summer and can't recall if I skied that winter but if I did it would have been with my pre-surgery brace. The winter after that (1.5 years out) learning to actually trust my knee sans-brace was the hardest part (I'd worn that thing for 7 years).

Over a decade later of hairball skiing and my ACL is rock-solid, both subjectively (I trust it) and objectively (professional wiggle test).

I wouldn't even consider the hammy, it's falling out of fashion. A family member was weakened and in pain for way longer than necessary in the modern era with that procedure. No matter what you chose, play it safe and wear a brace (a real one like football players use, get insurance to pay for it) the first winter out to give your support muscles and new ligament a chance to "set". Your body grows a new ligament in something like 3 weeks, but other rehabilitation processes (including mental) take longer.

Got a doc?

Thanks all, keep 'em coming! This is who I want to hear from! The experienced folks who had it done years ago and what they're up to now and the results...

I've interviewed four doctors - one in Kitsap (I'm in Bremerton), one at Swedish's ortho associates clinic in Seattle and one in Kirkland who is part of the Proliance system. The fourth guy is my stepuncle, an ortho surgeon in Minn., who recommended the Kirkland doctor. All of them work mostly on athletes.

Of those four, after I tell them I don't want patella tendon b/c of knee sensitivity, for the most part, 3 of the 4 went straight to hamstring while the one of them, who said hamstring would also work, then asked me "how do you feel about cadavers?"

One of them said no cadaver unless you're over 40 (I'm 35) and the hamstring may not work b/c i'm so short (4'11").

A couple folks who received hamstrings years ago said their legs seem to to have less muscle mass and it doesn't feel as strong but it still works but would have gone for patella or cadaver.

I'm about to say screw it, go for the patella b/c, despite the knee sensitivity (which HAS gotten better in my other knee that was done, just, it took 15 years to get to that point), I know it'd be strong.

Granted, 17 years ago, I wasn't exactly the athlete that I am now (or rather, as active, I'm just a putzer in the mountains who likes to get out) but I definitely know my ski season is out for next year (maybe cross country, just to do SOMETHING). I'm a stronger runner and backpacker than I am skier, so that's something to consider ...

Anyway, keep them coming! I'm really valuing this!

Thanks!

I've never heard of age considerations on cadaver. I had mine done at 22 and a family member had his done via cadaver at 19. That lack of strength on the hammy your friends noted is probably the "weakness" my female relative described with her ham job.

I have my both ACLs gone. The first (left) was reconstructed with hamstring tendon. Very difficult and painful rehab, about a year. Since I didn't feel much instability with the second rupture (right), I decided to wait and ski with brace (Donjoy, prescribed) and so far so good, although I am more conservative. If I had any instability while walking and skiing, I would have it repaired.

I did a lot of PT after the second unrepaired tear. I feel it is really important, both after surgical repair because there is a massive injury to muscles and nerves during repair, especially when autograph is used, and after tear without repair to strengthen the muscles. I feel my repaired leg is slightly stronger than the unrepaired one but almost two years after injury this difference is vanishing.

Regarding the brace - I am wondering how effective they are. I like to wear one but many people question their efficacy in injury prevention. I think at least it reminds me that I have to keep my form together and be in control while skiing. I run but I don't like to do contact sports.

When I had my other one done 17 years ago, the doctor said I'd never need a brace and I still never have. Unless I slam it hard against something, like the road after crashing on my bike, it feels very strong.

I'm down to deciding between doing patella and just dealing with knee sensitivity in BOTH knees (since I had patella done in the 17 year old one) or hamstring. The idea of a weakened hamstring concerns me though.

I tore my right/dominant ACL in november 2009. I skied a few times after the tear to get my leg strong before surgery and had a hamstring graft late in december 2010. Pretty painful for a few days, but I was off crutches in a week. Ready to be off in 3 or 4 days but the doc and PT advised against it. I rehabbed religiously, every day, according to a pretty standard protocol, and skied for the first time at 6 months to the day post op. A week later I skied the SW chutes on Adams, and a week after that Lava Ridge. Also had a fun little attempt at Shuksan North Face with Dave Brown somewhere around then that included some pretty heinous bushwacking. Never had any problems then and I have no recurring issues to date. I sometimes have to think hard to remember which knee I busted.

One note I feel strongly about is the use of a brace. I wore a brace for the 3 days following surgery, but never again after that. My doctors and PT were primarily concerned with me regaining full range of motion. When I started skiing I wore one of those black sleeve like braces that have two velco closures-- one above the knee, one below-- primarily to keep my knee warm. It also provided a gentle reminder to ski conservatively. I stopped wearing the sleeve after a year. I believe one of the reasons that my rehab was as sucessful as it was is because I never favored my knee. I could be completely mistaken, but I think wearing a structural brace inhibits the strengthening of stabilizing muscles.

Also, who were your doctors?

As a sidenote, I ski with full hinged braces on both knees....both knees had ACL tears...one knee two ACL replacements....

I have had three times over 6 years where I can personally say, "Wow, thankfully I had that brace."

I was wearing my Rx $1500 brace when I re-re-tore my ACL the last time- very simple small drop to a balanced but hard landing that I skied away from, but the damage was done. These braces work well for preventing injury due to lateral impact and thus can protect against MCL tears, and they also will prevent injuries due to hyper-extension. But there isn't a brace made that will really protect against the rotational force that can rupture an ACL. It was great for skiing the rest of the season without the ligament as it really helped stabilize and reduce the load on the injured knee.

This athletic brace is different from the post-op brace, which my last doc also did not prescribe. The first few days post-op were a little weird as there was no brace to prevent range of motion or guard against stepping on it wrong but then you get used to it.

I had my ACL repaired in 1995 at the age of 37; with the patella tendon method. Very painful recovery, I have a fairly high pain tolerance and have had 2 back surgeries, but the ACL hurt. Took me a full 2 years to get back 95% mobility. I'm 56 now and still bike, climb, ski, etc... Occasionally gets a little tight with some minor pain on longer multi-day climbs. Other than that it's pretty good.

Best of luck.

So, the final decision is to go with a quadricep tendon, by Dr. Green at UW sports medicine center! Thanks again for all your input!