Opinions on Allograft for ACL

[chewymix]

http://www.sportsortho.co.uk/left-na...l-graft-choice

I think it would be allo for me if the time came

[M_R]

Meetball,

Good luck with the surgery.

As for what Sharky experienced, although I'm not a doctor i believe this had little to do with Allo vs. Auto. as I had a similar experience granted it went away in about 3 weeks.

I had the same thing happen with my Autograph, but here is why. Both Allo or auto procedures require the surgeon to cut through the synovial membrane that surrounds the knee joint ( The type of membrane that lines the knee joint is the synovial membrane. This type of membrane allows the fluid that it secretes to lubricate the joint. synovial joints are extremely important for joint health.) . What was explained to me was that this membrane is almost like a balloon that encloses your entire lower leg skeletal system. What my doc did not know during surgery was that I has a bakers cyst behind my knee. The cyst was ruptured during surgery and or after surgery and the liquid made its was into that membrane (balloon) and through gravity worked its way to my ankle! To emerg I went, calf and ankle black and blue less than a week post surgery and swelling and fucking hurting like crazy. Fear was of thrombosis (blood clot in the leg) so they put me on blood thinners as a precaution untill it was figured out what happened.

This swelling and the added pain had nothing to do with alllo vs auto choice, but do be aware that whatever your choice it , the possibility of complications is always present.

As for the Auto pain. You get a nerve shot of painkiller in your leg that last for 2 days, so no pain initially, but then you do feel the discomfort kick into the hamstring during the first couple of weeks. Nothing like the ankle swelling. The hamstring healed fine and was ready at the same time as the knee and never bothered me. Only at extreme exertion would i feel the 5% loose in the form of tightness where the graft was taken ie: on the third hour of an aggressive group ride attacking a big climb i would feel it, but the first two hours were always fine. and today 10 year later I never feel it and the knee is rock solid, except for the 90% missing meniscus but that's another story.

As for odds of infection, I agree they are low for what is known, but the unknown is just that, unknown, and I guess it depends what your family looks like. Me I've got 2 young kids and even 1 :1,000,000 is too big of a risk for me and my family.

Sharky hope everything goes well and your knee heal up to 100% of what it was before your injury, just a heads up that in my experience, even though you might be back to sports in less than a year it takes about 2 full years to get all the kinks and nerve damage and bone growth and revascularization out of the way to get to that 100%

I would not hesitate to get a few opinions. I had a hamstring reconstruct 5 1/2 weeks ago from a Surgeon with 10+ years experience and claimed to have done over 400 acl procedures. I felt comfortable somewhat before surgery with the decision.

In the beginning he suggested hamstring autograft. I felt comfortable with his decision. 2 weeks later pre op, he suggested we do allograft!! I was like WTF? Why did it change? I am 39 and a medium duty athlete, but work heavy construction and lots of packing heavy materials on the job.

Personally, I think he forgot he told me autograft, so when questioned, he exclaimed I could do either, but that the allograft would heal quicker and be a faster procedure along with being plenty strong. I was concerned with long term failure, using my own stuff rather than a possibly infected person or the slim chance of a possibly weak or already damaged tendon. How would one know? He said he looks at them and if it was "orange or yellow" he could pick another one.

I opted for the hamstring at the last minute before surgery. Went under general anesthesia, and woke up a few hours later. Came out of recovery and that's when the pain set in.

She (the nurse) had me get up and use the restroom, then I was released to go home. The pain was brutal and only got worse. The doc said it would subside after 48 hrs.... BS!! 48 hrs later I was headed to the ER With massive swelling and brutal pain in the calf. My ankle was swollen to 13 1/2". (Other ankle was 9 1/2") I was taking warfarin/Lovenox for a previous blood clot in the calf.

He blamed the pain on the clots and prescribed dalaudid and percocet which I alternated the two and was taking 12 of each every day!! I am not a pill person so my tolerance was not built up. The pain was excruciating for the next 2 weeks!! The 25 pills a day was barely helping. And my calf was swollen seriously and hard as a rock.

It has been 5 1/2 weeks now post op. I am still on crutches and trying to get off the pills. Taking 6 or so a day now but still brutal. The knee I have been constantly elevating since the beginning and ice. He can't explain why it has taken so long to heal, as well as my therapist. I was injected with a steroid shot a few days ago as he said that would "jump start" things. It has done nothing. Pain is still 8-10 and I don't have the feeling I will be off crutches anytime soon. Mind you, this was ONLY an acl reconstruct. Everything else was supposedly ok.

Maybe I am just unlucky, but I sure wish I would have gotten more opinions. Just my 2 cents. Good luck.

[meatball66]

Thanks for the notes MR. Will give an update next week!

[meatball66]

Had it done today. Glad to be counting up towards recovery as opposed to counting down to surgery day. I guess things are really different than they were 20 years ago.

- leg immobile due to the allograft. When I had the autograft, we were bending immediately
- do driving for two weeks, This is a surprise and a big inconvenience
- 6 weeks on crutches and in brace
- 3 months of PT 1-2 times per week. I did none 20 years back.

[climberevan]

Good luck with the recovery! It's rough, but it will be over before you know it. For me the first week was the worst.

I had an allograft 18 months ago for 3 reasons: faster healing (so I could get back to work at least, but not sports), no chance of hamstring tightness in the future (affects some people who have the hammy grafts), and no front-of-knee-pain when kneeling (affects nearly everyone who has patellar grafts for years afterwards, and I'm a carpenter). I have no regrets, and would do it the same way again.

I was also surprised by the immobilization. I wasn't expecting it, but apparently my meniscus was pretty trashed too, so they actually repaired it, and that's why I had to be even more careful than usual.

Ride road bikes as soon as they'll let you, and ride them a lot! FWIW, I did 2 sessions of PT total--the rest was on my own. Insurance wouldn't pay for it, and the PT people basically said "Just ride your bike and keep doing what you're doing, because you're way ahead anyway." In 6 weeks or so get a BOSU ball and do tons of 1-leg squats on it: I think it's about the best thing you can do.

[meatball66]

Climberevan
Thanks for the advise. I did as much road riding on weekends and on the trainer weekdays leading up to the surgery. I plan on a lot of road riding as soon as possible. I agree with you regarding the PT, I'll want to take it easy and not push too quickly, that is the downfall of the allograft, but I'm sure I'll be on my own after a couple PT sessions.

[meatball66]

Twenty years sure makes a difference because I was miserable with pain the first 14 days, I don't remember being such a wimp when I had the patellar autograft procedure 20 years back. Getting much better now. I can actually concentrate and get work done. PT going well, riding the bike on day 15.