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everyfrog
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everyfrog
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PostWed Dec 03, 2014 11:51 pm 
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!

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Bedivere
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PostThu Dec 04, 2014 1:16 am 
I've had two very different experiences with hamstring grafts. Had my right knee done in '95. Of course, I was only 27 at the time so that may have played a big role in how I was nearly fully recovered at 6 months. Repair was in February and I was backpacking off-trail for a week at a time by August and skiing again (with a brace) the next year. Left knee was done in April '13 and it's STILL not fully recovered. I didn't hike at all summer of '13 and didn't ski last season. I did quite a bit of hiking this last summer and had some pain issues on my one long trip which involved a lot of boulder hopping and rough-terrain travel off-trail. I'm hoping to ski again this winter. I think part of this is that I'm now 46 and part of it is that I didn't hit the PT as hard this time around due to various lame excuses, but the main issue has been pain. The knee will get to feeling good, I'll start working it harder and then it'll flare up and start hurting. In any case, my left leg is still weak and I still have some pain in the patellar area as well as some mild proprioception issues (which have nearly disappeared in the last 3 months of more intensive activity). I think there may be some cartilage damage at the front of the knee under the kneecap that wasn't caught at surgery time either as the knee is very "crunchy". If I had the left knee to do over again, I'd go cadaver. Taking the ligament out of your hamstring traumatizes and weakens the hamstring. Your hamstring is important to stabilizing your knee and it takes a long time to get the strength back there. Recovery from a cadaver graft should be much quicker and less painful. I elected not to do it this time because of a slightly higher failure rate and/or the possibility of cadaver material either being rejected by the body or being more likely to stretch out and get loose over time. I think I would risk it though if I had it to do again as regaining the strength I've lost is proving to be quite the challenge at my age with a desk job and long commute and there only being so many hours in the day. so that's my story. Take out of it what you can, your situation is probably different. In any case, good luck and a speedy recovery!

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tigermn
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PostThu Dec 04, 2014 9:41 am 
Knock on wood haven't had knee problems yet but good information. On the surface from the peanut gallery I'd be more inclined to use cadaver if for no other reason, why potentially mess up something else (hamstring)?

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moonspots
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PostThu Dec 04, 2014 10:20 am 
tigermn wrote:
Knock on wood haven't had knee problems yet but good information. On the surface from the peanut gallery I'd be more inclined to use cadaver if for no other reason, why potentially mess up something else (hamstring)?
That was my first thought also. However, I'd do a LOT of research on the condition of the donor material before committing. Not that I have any personal experience, but many years of life experience suggests to me that this is more important than getting OEM (vs cheaper knockoff) parts when having car work done. Anyway, that's what I thunk.

"Out, OUT you demons of Stupidity"! - St Dogbert, patron Saint of Technology
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coldrain108
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PostThu Dec 04, 2014 10:41 am 
A guy I work with has had both knees done. The first was with his own donor tendon and he said it took forever to heal right, mainly due to having two trauma's to deal with instead of just one. For the second surgery he used the cadaver tendon and he said it was night and day difference as far as recovery goes. He is in his early 30's. He is a surfer, skier, climber and hiker and back in full swing. When I badly twisted my knee, he was outspoken about using the cadaver tendon if that wound up being my destination - luckily for me my knee recovered w/o medical intervention - took 2 months of laying low.

Since I have no expectations of forgiveness, I don't do it in the first place. That loop hole needs to be closed to everyone.
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RichardJ
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PostThu Dec 04, 2014 11:16 am 
I had the ACL reconstruction on the right knee using 1/3 of my patellar tendon about 25 years ago. Rehab was not fun and I was back to work (in a job requiring heavy lifting) in 5 months. I can honestly say that to this day it feels as strong and pain free as ever. No weakness in the patellar tendon that I can tell. It took some years, but I have no pain when kneeling. Still properly tight. I had previously partially torn the ACL in both knees from basketball and skiing and my knee joints were loose with lots of side to side movement. Finally I tore the right ACL completely through playing basketball and had to get it reconstructed. At the time of rehab I had lots of doubts it would ever be the same and I would have full motion. After all these years it still feels good as new.

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tigermn
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PostThu Dec 04, 2014 11:42 am 
No artificial tendons yet? One would have thought that might have been something invented by now... I mean you have artificial hearts and who knows what else.

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everyfrog
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PostThu Dec 04, 2014 1:46 pm 
You all are great! Thanks and keep them coming! Being 35 compared to 17 when I had my other ACL done is a factor for sure. I too have a desk job but I'm also out in the field for work (forest, hatcheries, water) April-July. Part of me thinks that while the initial pain upfront with the patella is worse, it's worth it b/c of the stronger ligament in the end. And my knee sensitivity has decreased considerably the past 3-4 years. I've pretty much given into the fact that my intensity levels will be put on the backburner for the next few years and I need to watch myself so I don't overdo it (because I DO tend to do that). Thankfully, I have a boyfriend who just moved here from Florida, and he's starting from ground zero in building up his hiking strength with all our hills around here, so that will be helpful too in keeping me in check. Anyway, more stories would be great!

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moonspots
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PostThu Dec 04, 2014 2:55 pm 
tigermn wrote:
Knock on wood haven't had knee problems yet but good information. On the surface from the peanut gallery I'd be more inclined to use cadaver if for no other reason, why potentially mess up something else (hamstring)?
That was my first thought also. However, I'd do a LOT of research on the condition of the donor material before committing. Not that I have any personal experience, but many years of life experience suggests to me that this is more important than getting OEM (vs cheaper knockoff) parts when having car work done. Anyway, that's what I think.

"Out, OUT you demons of Stupidity"! - St Dogbert, patron Saint of Technology
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Bedivere
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PostThu Dec 04, 2014 4:51 pm 
I shopped around a bit for a knee surgeon this last time around. It came down to a young "hotshot" who'd done his residency at the center for special surgery in New York and was now onboard at UW Sports Medicine or an older guy with many years experience who is a team doctor for the Sounders at Swedish. The young guy was pushing the cadaver route due to the factors I listed above. He said patellar grafts are usually reserved for true athletes like the UW football players because they'll do the hard PT to get back in the game and are used to dealing with the higher pain levels. He said the patellar grafts are the strongest repair also but have much more pain and a little longer recovery time for average folks. Maybe I should have gone with him. It was my impression that you don't get any choice in the source of the cadaver material - it comes from a bank and who knows who the donor was. It's irradiated to sterilize it but this also causes the potential weakness/stretching over time. I went with the older guy, figuring I'd take experience over youthful enthusiasm and he was recommended by a couple other skiers as well. He gave me the option of either cadaver or hamstring, didn't really push either one and understood my concerns about the cadaver route. I figured since I'd had such a good experience with the hamstring in the past, that it would be just as good this time around.

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glenoid
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PostThu Dec 04, 2014 5:25 pm 
Ten years ago I did a number on my left knee (torn ACL, PCL, medial and lateral meniscus, and the medial collateral ligament) Got the patellar graft as my tendon was big enough. (I might be 65 inches tall stretched out, and really not football player material) The repair is fine for me. With only a numb sensation over the surgical scar. The knee is stable and I do what I want with it. Would I do it again? Probably not. Not because the repair wasn't good, but because of all the complications I got from having surgery. (A deep venous thrombosis from calf to navel with massive leg swelling and a pulmonary embolism). My brother (CT) had a somewhat similar wrecked knee and opted for no repair. I believe his knee is probably the same as mine or better. I personally would think first about even doing the surgery before I would worry about the type of graft I would be getting.

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Bedivere
Why Do Witches Burn?



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Bedivere
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PostThu Dec 04, 2014 7:07 pm 
glenoid - how did you injure it? Do you ski or participate in sports that put a lot of stress on the knee? What the doctors have told me is that while I *might* be able to get away without a repair, over time I would develop stability issues that would get worse as I got older and could result in cartilage damage. I've got a lot of big, steep mountains left to ski. Not willing to deal with those kinds of issues.

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cascadetraverser
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PostFri Dec 05, 2014 3:44 am 
Thought I would chime in on this one; I tore my MCL, ACL and lateral meniscus 3 years back; given my age, 50 at the time and desire to avoid a 6-9 month rehab and on the advice of an Orthopedic PA, and an Orthopedist and knowing the history of my brother`s less than successful ACL tear/repair (Glenoid) ,I decided to try to live with my knee w/o surgery. As a physician myself, I have always felt the body can naturally heal itself and compensate for an injury given time, patience and training/rehab. My plan was (and still is) to consider a new ACL if I were to develop instability. I should add I have pretty strong bulky leg muscles, but I suspect that is the norm on this site smile.gif Initially, I did have a few unstable moments but after I got my strength back, I have done just fine. I did a traverse 6 months later and had a great ski year the following winter. I use a Townsend brace only when skiing (although honestly probably could do w/o). 3 years after the injury I am doing fine and continue to ski and hike/traverse just like always. I do excercise alot and stretch regularly. I suspect my story is not that uncommon at all btw...

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tom roy
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PostFri Dec 05, 2014 7:53 am 
I would mention a good surgeon is everything plus listen to the PT people on rehab. My friend in Bellingham is six years older than me. We had much similar situations. Blew our knees up in the early eighties and lost most of our cartridge.We both had replacements in the last couple of years. I was going well after six months and he has never been quite happy with his. When he talks about just getting his knee iced after surgery and I have always had a ice water pump used on me. Just one of the red flags I see when he talks about his surgeon. It was never even offered to him insurance issues or not. Mine even came home and I still have it very small slick thing for icing a knee. Do your homework.

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glenoid
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PostFri Dec 05, 2014 9:16 am 
Bedivere: Tore everything up skiing!! Too loose alpine boots allowed my heel to raise up about three inches inside the boot. The back binding didn't get stressed and wouldn't release, instead my knee did-ouch. (Did ski down from the top of Schweitzer on it.) doof.gif I continue to telemark, downhill ski and snowboard on it. Hiking doesn't bother the knee at all, but the leg swells from the clot damage. Rock climbing is hampered by my knee's lack of full flexion (the leg clot caused so much swelling that PT did not progress well) My other knee has the meniscus torn off from it's bony attachment. It is more of a problem, but I get by...Nobody is touching it till I can't ski or hike anymore.. My preference now (after lot's of experience) is to build up the muscles around my knees to the max for stability. I will do what I want in the meantime. When I can't do what I want to do anymore, then I will get a tune-up or repair. As a physician, I see a lot of "work" done on people, which IMO is done "too soon". I wonder a lot about who is benefiting the most from these surgeries!

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