ACL Surgery - Graft Choice

[amazon_blonde]

Arggggg. I just blew my ACL in Jackson Hole on Wednesday! This thread has been a good discussion, but I'm more confused than ever about graft choice. Patella sounds like decent risk of future pain and long rehab. Hamstring graft sounds like many people feel the donor site, but it's not a big deal. Other than being weird, it doesn't sound like anyone had a bad experience with allograft?

I have also heard of a synthetic?

I'm a bit to surprised to hear about pre-hab? I thought it was best to get the surgery as soon as possible. Also, I can't imagine doing prehab. 4 days post accident I have very little range of motion and serious discomfort on weight bearing attempts. My knee is very unstable and collapses inward with the slightest pressure! Painful.

How much work did you divas with ACL reconstruction have to take off work? I'm a bit concerned about the non-sport consequences as well.

 

[altagirl]

I'm a bit to surprised to hear about pre-hab? I thought it was best to get the surgery as soon as possible. Also, I can't imagine doing prehab. 4 days post accident I have very little range of motion and serious discomfort on weight bearing attempts. My knee is very unstable and collapses inward with the slightest pressure! Painful.

How much work did you divas with ACL reconstruction have to take off work? I'm a bit concerned about the non-sport consequences as well.

So sorry to hear that! Very few doctors are willing to do surgery immediately after an ACL injury, while the knee is still swollen (unless you do sufficient whining and have some reason). I think the fastest I did was just under 3 weeks? The biggest thing is getting the swelling down, and that takes a while. If you have surgery while it is still significantly swollen, you are setting yourself up for more scar tissue and a more miserable rehab.

My co-worker just did that this fall. Tore his ACL playing soccer, decided that for work reasons he wanted surgery immediately and talked his doctor into it a week or so after the injury. He was kind of a mess for a while and they thought they were going to have to work on his range of motion under anesthesia because it wasn't progressing properly. He was able to work through it, but adding miserable weeks of stress that you might have caused permanent damage having surgery too soon and just the misery of fighting scar tissue you could have avoided? I don't think it's worth it.

I know the one "problem", is that once you get the swelling down after the initial injury, I've felt good enough that it's like "what am I having surgery for again?" The torn ACL itself usually only causes instability issues when you're pivoting/turning. All that other pain is either torn meniscus or just the effects of all that swelling through the joint.

 

[Pequenita]

Oh, amazon_blonde, I'm so sorry to read this!

One of reasons for the pre-hab is that a lot of times, people injure something else in addition to the ACL, so after surgery, mobility is limited because multiple things are healing. Especially if there is an autograft. Regaining muscle when unable to move is, obviously, challenging, so it's better to start off with strength.

4 days post injury, you probably still have swelling in the joint. Once that swelling goes down, if your only injury is soft tissue, you likely won't even realize that you have an injured knee if all you're doing is just walking around. Pre-hab won't start until the swelling goes down.

I've written in numerous threads that back in the "old" days, most non-pro athletes did not get an ACL reconstruction because it was super invasive and the injury not life threatening. The jury is still out as to whether a reconstruction has an impact on osteoarthritis. A friend's 70+ mother ruptured her ACL in the 1970s or 1980s and never had it repaired and has always led a very active life, including downhill skiing. She just wears a brace instead. I know that many of us on this message board lead very active lifestyles, but to think that one must immediately get an ACL reconstruction upon rupture is, imho, not considering all the options. This last statement wasn't directed to anyone in particular.

Time off...each doctor has a different protocol. I took 17 days, including the day of surgery, before I went back to work. This included weekends and holidays; I scheduled a Friday surgery and it was around U.S. Thanksgiving. There's a lot of elevation and icing that goes on initially post surgery. And pain management.

 

[amazon_blonde]

Thanks ladies. The rest before surgery makes sense with this explanation. I can't fathom prehab now, but I have a very serious bone bruise and maybe some other complications, which are causing the zero range of motion. I have heard of people not doing surgery -- my own uncle tore *all* the ligaments in his knee and did not reconstruct -- but I'm seriously into skiing and climbing among other things and still want 40 years out of this knee so surgery now seems reasonable.
Given the wait time for surgery in Canada, I'm not going to get surgery quickly, and this makes me feel better about it.

 

[Pequenita]

Random thought about allograft: an autograft "slows" down – in a GOOD way – how quickly patients resume "normal" activities because you are healing from two procedures, essentially, and the pain from both of these procedures often guides patients as to when it's okay to go back to doing normal things. Let's face it, some of us do stuff as soon as it feels okay to do stuff, not when the doctor says it's okay.

It takes more discipline with an allograft to let things heal because people often don't feel as much pain from one procedure and think they're okay when there is still healing to be done at the reconstruction site.

I would feel most comfortable doing whatever graft the surgeon is most comfortable at doing, if there's a huge discrepancy.

Re wait time, I waited 4 months. I had a lot of time to go through the stages of grief!

 

[Downunder Diva]

Arggggg. I just blew my ACL in Jackson Hole on Wednesday!

I'm a bit to surprised to hear about pre-hab? I thought it was best to get the surgery as soon as possible. Also, I can't imagine doing prehab. 4 days post accident I have very little range of motion and serious discomfort on weight bearing attempts. My knee is very unstable and collapses inward with the slightest pressure! Painful.

How much work did you divas with ACL reconstruction have to take off work? I'm a bit concerned about the non-sport consequences as well.

Poor you amazon_blonde, this is indeed a 'bummer'... I agree with what everyone else has said. It's unusual to only rupture an ACL there's generally other stuff going on as well (personally I also ruptured MCL and tore meniscus)... so the immediate acute phase post injury is to reduce swelling - lots of ice and elevation. I used a compression brace on my knee initially after the injury (I did it on a work trip and still had to fly/work for 7 days before I could see a doctor - you should have seen my face and heard my expletives when I arrived at the Brisbane accommodation with 4 flights of stairs! I had to go up and down backwards . This is one operation that does not need to be done within any time frame. As others have said the ACL despite being a Cruciate (crucial) ligament can be dispensed with - NBA player DeJuan Blair plays basketball without ACL's in either knees due to his quad/hamstring muscular strength compensating for the lack of ACL's. I had 6 weeks off work but I could have gone back after 4 weeks however my post op rehab program would have suffered. Good luck with your journey and keep us posted...

 

[MaineSkiLady]

So sorry to read this, amazon > best of luck to you. DH had an allograft patella tendon 2 years ago, just under 4 weeks after the injury (did pre-hab despite meniscus involvement, after 5 days of no weight bearing pending MRI results). He had stuff happening at work starting April 1, had the surgery 3/2, was back at work end of March. It wasn't easy, but....he had to be there. He whined plenty, post-injury, post-surgery, never thought he'd be the same again. Famous last words. Like it never happened. Quite amazing.

 

[jaggedmaggie]

Random thought about allograft: an autograft "slows" down – in a GOOD way – how quickly patients resume "normal" activities because you are healing from two procedures, essentially, and the pain from both of these procedures often guides patients as to when it's okay to go back to doing normal things. Let's face it, some of us do stuff as soon as it feels okay to do stuff, not when the doctor says it's okay.

It takes more discipline with an allograft to let things heal because people often don't feel as much pain from one procedure and think they're okay when there is still healing to be done at the reconstruction site.

I would feel most comfortable doing whatever graft the surgeon is most comfortable at doing, if there's a huge discrepancy.

Re wait time, I waited 4 months. I had a lot of time to go through the stages of grief!

I would agree that in having the allograph, I didn't have the horrible long recovery pain but, my doctor was very clear (for months) that I was NOT healed. It might feel OK, but in this instance, it's not OK. He said no running (or jogging), twisting, cutting, slipping(!), also warned against leg extensions (weight lifting) for the first 4 months. The remodeling of the ACL he said takes a solid 8 months. The reconstruction cost $40,000 ($10,000 out of pocket) so if for no other reason, I was determined to follow the rules!

Also, please, for your own good, have some form of health insurance! Even just an accident policy is better than nothing.... don't find yourself needing care and having your options limited!!

 

[Downunder Diva]

Also, please, for your own good, have some form of health insurance! Even just an accident policy is better than nothing.... don't find yourself needing care and having your options limited!!

I absolutely agree with this jaggedmaggie. I was only able to have my reconstruction done because I have private health insurance cover. In Australia the public health system is excellent but even so they would not have performed ACL reconstruction on me as a 51 yo woman due to the national health system perception that 51 yo women do not engage in strenuous sports - hence do not meet the pre-op criteria (don't you know us biddies in our 50's are just marking time to meet our maker and flower arranging of course :D) As an aside the ACL reconstruction cost $3500 for which I was $800 out of pocket. My health insurance fund covered the rest including the private hospital overnight fees.

 

[amazon_blonde]

Health insurance in Canada is fundamentally different than in any other country. Without going into the details, there is no official private system. We have "extended" insurance options but not private insurance options. the public system is comprehensive and insurance is not optional. That isn't to say that private services aren't available, but it's different than in the US, Australia, NZ or Europe.
Travel insurance is different, and it was a good thing I had coverage for service in the US where I got injured.

 

[MaineSkiLady]

I would agree that in having the allograph, I didn't have the horrible long recovery pain but, my doctor was very clear (for months) that I was NOT healed. It might feel OK, but in this instance, it's not OK. He said no running (or jogging), twisting, cutting, slipping(!), also warned against leg extensions (weight lifting) for the first 4 months. The remodeling of the ACL he said takes a solid 8 months. The reconstruction cost $40,000 ($10,000 out of pocket) so if for no other reason, I was determined to follow the rules!

$40K! WHERE on earth do you live?
Grafts undergo a "weak phase," which starts at 8 weeks post-op and lasts until around 14 weeks - so 6 weeks where the graft is particularly vulnerable. Prior to 8 weeks and after this phase, rehab is hard and heavy. DH was cleared to water ski (and did) in mid-August, so 4.5 months. Strength and function tests are a total part of PT/rehab, so there will be variations between individuals. My son was over the top at 5 months post-op, but he worked incredibly hard, and to the letter.

(don't you know us biddies in our 50's are just marking time to meet our maker and flower arranging of course :D) As an aside the ACL reconstruction cost $3500 for which I was $800 out of pocket. My health insurance fund covered the rest including the private hospital overnight fees.

.... 50's, eh? Well, I guess I should be flower arranging for my "imminent departure?"

No overnight, no hospital for many/most US knee surgeries of this nature. DS and DH had to stay in nearby hotels first night after surgery, due to our living out of town from facility (outpatient surgery). Otherwise, if close, you go home. Rehab begins within 2 weeks, sometimes sooner.

 

[Downunder Diva]

.... 50's, eh? Well, I guess I should be flower arranging for my "imminent departure?"

:ROTF:
I think as long as your 'flower arranging' is not the 'wreath' to adorn the casket for your 'imminent departure' else is indeed morbid... :D However I think - as mature aged biddies - we should be arranging our skis downhill on the slopes...

No overnight, no hospital for many/most US knee surgeries of this nature.

This is interesting as it's pretty much standard practice to hospital overnight in Aus...

 

[skidoc120]

This is so helpful to me! I think I sprained my ACL a couple of months ago indoor surfing. I was afraid I would need surgery since high impact is till painful, but so glad to hear that surgery is not necessary for partial ACL tears. I'm quite sure I didn't tear through it, but I don't have health insurance coverage and probably can't qualify for any. How do I know if I am OK to get up on skis? I have moved back to Utah and had to take a job without benefits to get back here. I'm in my 50's and not ready for flower arranging either!

 

[jaggedmaggie]

This is so helpful to me! I think I sprained my ACL a couple of months ago indoor surfing. I was afraid I would need surgery since high impact is till painful, but so glad to hear that surgery is not necessary for partial ACL tears. I'm quite sure I didn't tear through it, but I don't have health insurance coverage and probably can't qualify for any. How do I know if I am OK to get up on skis? I have moved back to Utah and had to take a job without benefits to get back here. I'm in my 50's and not ready for flower arranging either!

Try ehealthinsurance.com, they carry some accident policys for $15-$40 a month. It depends on where you live, as different policies are available in different states. Accident policies don't cover much, but could take a big bite out of an injury. (Did you know a bee sting is an injury? So is knocking a tooth out) Make sure you read the fine print as some don't cover skiing (or climbing, hang gliding etc). I just bought one... it took 2 weeks to become active and you can cancel at any time. Also try Mutual of Omaha... in Colorado and Utah they (at one time) were offering a $39/month, 0 deductible up to $5000 per accident.

 

[altagirl]

As far as functioning without an ACL goes, my understanding is that it depends somewhat on your genetic design. Not everyone's knee is shaped exactly the same, and some have more structural support from the bones and cartilege alone than others. This also probably depends largely on the condition of your meniscus. I can think of at least one pro skier who has gone without an ACL for over 5 years.

I went for a year before having my first torn ACL reconstructed (not by choice), and got 28 days of skiing in with no ACL. It gave out every few ski days though, even while wearing a brace. At that time I had pretty huge leg muscles - I was really into weightlifting before that and after the injury it made me even more concerned with keeping the muscles strong. I went running twice a day during that period because it kept the swelling down. But eventually, my knee would give out on me just walking around a corner in a hallway. Once I was helping some people move a picnic table and the lateral force of picking it up and trying to take a step made my knee give out. I had some torn meniscus problems too, so maybe that's more related to the meniscus than the missing ACL.

But it's also hard to know for sure if you have a torn meniscus until you have surgery. They often do not show up correctly on an MRI. It's not going to hurt, I don't think, to see how you function without it. You might be lucky.

 

[pinto]

Sorry to hear this. (I'm also sorry you missed the following days of skiing in JH! It looked epic)

The bone bruise will hurt longer than the knee, I'm pretty sure. THose things take a while to heal. Good advice given in the preceding ... my husband skied 3 seasons without his acl, but did have it fixed last spring. He had an extremely easy surgery and recovery, was driving within about a week? 10 days? Hardly any pain or swelling, ROM was there from the get-go ... he was discharged by the doctor within a few months.

BUT then (the cautionary tale) slacked on his rehab because he felt so normal. Skiing has been a bit tough for him, so he re-entered rehab a few weeks ago. (That sounds funny ... cue Amy Winehouse) Anyway, I almost think it would have been better for him if the surgery and following few months hadn't gone so well.

 

[skidoc120]

Thanks for Ski Diva wisdom!

I think I am going to give it a try on Monday; I'll take it easy and see how it goes. Thanks!

 

[amazon_blonde]

So far one sports med doc and one ortho has recommended surgery. I'm seeing another and will go from there. But If I wait on surgery, I may miss 2 ski seasons (based on timing) and climbing season. So I think I will fix surgically sooner rather than later.