tore my acl/mcl/lcl/meniscus... searching for answers

[famid]

Hi everyone,

First timer here. I'm sad to report that I tore my ACL, MCL, LCL and partial meniscus tear three weeks ago in Aspen. Last run, last day. Skied alone because my flight was canceled and everyone else in my group got out. Pretty cliche, pretty horrible. Wasn't focused and attacked a cat trail head on from a steep. Made a last second turn and my ski got caught, but my body kept moving. Had to ski the rest of the way down and heard another pop and crumbled to the ground. Skied the remainder on one leg.

As I'm sure you all know, it's been a rough ride. Can't stop thinking about what I could've done differently. What I should've done differently. It's a back and forth of shock and disbelief, and acceptance and resolve.

I've been scouring the boards to learn as much as possible. It's crazy how fixating this process is. What's striking is the unfortunate lack of consensus on which graft to use. You read all the literature, but eventually, it all begins to sound the same. Patellar is strongest, but results in kneeling pain and potential tendinitis/arthritis. Hamstring not as strong but less morbidity from the graft site, but you lose 10-15% strength in your hammy. I was hoping some people here could let me know their personal experience so I can maybe make a more informed decision based on my personal situation and wants.

I'm 36. Short at 5'7, but athletic build. Extremely active. Exercise every day and pound my knees in the process... plyometrics, bootcamps, crossfit, skiing, bball, etc. I go pretty hard. And my key concern is getting back to form. Being as competitive as I was before and not losing a step. I've gotten two opinions, one doc says hamstring, the other says patellar. I'm leaning towards hamstring because I'm afraid that the patellar will cause a great deal of knee pain and make it difficult to ski, play tennis and bball. But then I'm afraid that with the hamstring, I won't return to form b/c my hammy will lose so much strength. And most important, I don't want this thing tearing on me again. This decision has been driving me crazy.

Anyhow, sorry to bore you all with this. But these concerns have been plaguing me. And in my constant agony, just wanted to reach out to those that have experienced the same and hear a hopeful and friendly voice on the other side.

Best.

[chewymix]

Why not an allograft ?

[jma233]

A surgeon friend of mine recently referred his son to a colleage who performed the paterllar tendon graft. When I asked why he replied that he still considered the patellar tendon graft to be the gold standard.

[Rosebud]

Trashed the same 3 ligaments plus both meniscus just under a year ago. I was more concerned with finding a surgeon I could trust who performed complex knee reconstructions daily. Once I found that person, I pretty much put my faith in what they thought was best for me. My suggestion is go with your gut and less with what you read on the internet as it will become one big mind fuck.

I feel for ya. It's been a long road for myself. Best coping I found was/is just taking it day by day. Hopefully you have a good support system including a great physical therapist to help you get through the first few months since that will be especially difficult. Try not to compare your injuries/recovery too much to most others since it's not a simple ACL, etc... It will just piss you off ; )

I don't check this board often but feel free to msg me. Take care.

[Orthoski]

Famid...so sorry to hear about your injury. There are a lot of people among the collective that have the same "what if" story - what if I hadn't done that last run, etc. First and foremost, the determination you obviously showed skiing down on one ski after such a severe injury is what's going to get you through this more than anything else, including graft choice.

There's no magic bullet among graft choices. Someone who is as aggressively active as you may arguably benefit from autograft over allograft (the tradeoff is slightly higher re-rupture rates with the latter), but when it comes to patellar vs. hamstring graft it really is surgeon preference that makes all the difference in the world. Find a surgeon you trust and let him/her operate his his/her comfort zone - that's more important than anything. You had a severe injury and it's going to be a tough road regardless of a perceived hamstring strength decline vs. anterior knee pain. Sometimes, when something outside of our control happens, such as your injury, we tend to focus on the stuff we can control, like graft choice. But I can't imagine that someone who basically dislocated his knee and subsequently skied down on one leg doesn't have as good a chance as anybody on this forum to bounce back wonderfully. The graft choice doesn't strike me as what's going to make the biggest difference in your recovery. Your personality will.

Best of luck and keep us posted.

[ate'em]

I am 9 months out from doing my ACL.MCL.meniscus.TibPlateauFracture. I third the recs to find a doc you trust fully and do what he says. I used LaPrade at Steadman Clinic in Vail and have been thankful for that choice every day.

As far as the grafts go, I had my patellar tendon used for the ACL, and my hammy for the MCL. Both areas have their issues still, but I am confident they will be perfect with time (lots of time), and PT.

The patellar graft was really painful for a long time. It feels really weird kneeling on it still, but not painful. The scarring there is intense, and seems to be the slowest to resolve itself. There is still swelling in the patellar tendon, but like I said, I feel all good with it at this point and it is getting better all the time.

The loss of hamstring strength was nothing short of shocking. I have had to work my hamstrings in PT more than anything else. I dont have any uncomfortable sensations there, but the loss of strength was just tremendous. Like everything, it is getting better with lots of hard work.

I am suprised that you have much of a choice, my doc said that with the ACL/MCL combo, there wasnt really a choice. Had to use the hammy for the MCL, so that left the patellar for the ACL. He wouldnt consider allograft for someone of my age and demographic.

I am about the same as you, 5'6", age 34, super physical guy that farms for a living. Fully recovery was the only possibility for me. My doc agreed. My PTs pushed me to make it so. At this point, I am totally confident that all will be good, but it is going to take more than a full year to make it so.

Get a really, really, good surgeon, who doesnt flinch at the severity of your injury. You did a good one mate! I saw another highly regarded surgeon, but I could tell he was nervous with the extent of my injury. No bueno. I went with Dr LaPrade who was cool as ice, said he had done a hundred of these, and had no doubt that I would recover fully. That is the kind of confidence that you need.

The mental part is really the part that can get at you. So much patience and persistance needed. Good luck. Dont hesitate to PM if you need more info.

[spook]

yeah, whatever you do, don't get fat. it will destroy your knees a lot faster.

also, i'm struggling with long term issues from old acl/meniscus problems that have been making me worry about the future in terms of snowboarding. then i saw an amputee on one ski my last time up, and i was like, fuck it. i'll ski on one leg or a sit ski if i can't ride.

[spook]

and then i looked up at a barren mt. hood and added that i'll probably have to move

[famid]

hey everyone --- thanks for the kind words of encouragement. Ultimately decided to go with the BTB patellar autograft. Got a great surgeon and am just over two weeks out of surgery. Started my PT five days ago and feeling better. Still on crutches and with brace, but every day I seem to make a bit of progress. Goal is to ski Japan 2015!

[CarolB]

Seems hard to find a Doc that does this one but there are a few that swear by it. Opposite leg hamstring. Seems weird and people go,but doesn't that weaken both legs (after surgery) and the answer is yes but at least you haven't added insult to the main knee/leg.
When you rehab you do two legs anyway so they both rehab together. Supposedly a faster recovery (1/2 the time claimed). I know 2 people who did this route and they are high level athletes that agree this was so.

Why don't they do it more? Maybe the fact that it's more time on the table as you need to prep both legs. Less revenue?
Just another option for you.

[old goat]

Seems hard to find a Doc that does this one but there are a few that swear by it. Opposite leg hamstring. Seems weird and people go,but doesn't that weaken both legs (after surgery) and the answer is yes but at least you haven't added insult to the main knee/leg.
When you rehab you do two legs anyway so they both rehab together. Supposedly a faster recovery (1/2 the time claimed). I know 2 people who did this route and they are high level athletes that agree this was so.

Why don't they do it more? Maybe the fact that it's more time on the table as you need to prep both legs. Less revenue?
Just another option for you.

I don't know about Canada but in the US OR's charge by the minute--more time=more revenue.
I agree with those who recommend picking the doc and letting the doc pick the operation, rather than looking for a doc to do a specific operation.
(That doesn't mean you can't get a second opinion).
Have any of the ortho's out there injected thick, painful knee scars with steroids?--pretty standard in other locations but I have no experience with the knee.

[Orthoski]

I don't know about Canada but in the US OR's charge by the minute--more time=more revenue.

Sorry Old Goat - not true on this one. Hospitals are paid based on the procedure done, not how much time it takes. Other fields use the billable hour - not medicine.

[iceman]

I thought old goat was a doc, no?

famid, I am so freakin superstitious about exactly that situation I'll probably get run over from behind and killed one of these days. I even refuse to say the words "last run" when I'm skiing, seriously.

No advice here except keep your chin up and be happy we live in this age where recovery is even possible. Good luck man!

[detrusor]

True that surgeons bill on procedure. However, the hospital portion of the bill will have a time base in it. Also anesthesia is billed by time. At my old institution or time was $88/minute. Ouch

[old goat]

I over simplified. For Medicare--not relevant for most on this forum--there is a fixed fee based on the diagnosis. For an uninsured patient, or a patient receiving emergency care in a hospital that doesn't have a contract with the patient's plan, OR time is billed per minute. At the Kaiser hospital where I used to practice Kaiser patients weren't charged anything for OR time but nonKaiser trauma patients were billed by the minute. For hospitals that have a contract with an insurer it would depend on the details of the contract--might be time-based at a discounted rate or procedure based.

BTW some years ago a Stanford surgeon published an interesting study. When moving patients from the OR table to the recovery room gurney it is common practice for the OR team to move the patient on the count of 3. By moving the patient on the count of 2 Stanford Hospital could save $12,000 per year. The amount would be a lot more now. Of course at Kaiser we move the patient on 1.