Autograft (patellar vs. Hamsrting) Vs. Allograft

[HOBA]

Tore my ACL and I need to decide on the method of ACL reconstruction. How did you decide of types of procedure? Why did you choose one over the other? What is everyone's thoughts post surgery?

Thanks for your help.

I hate the idea of surgery

[cold_smoke]

I have a hamstring autograft in my right knee. i don't feel any problems with it 8 years later, but when tested it is noticeably looser then it should be...In clinical tests this has seems to be the case, hammys are known to loosen but it is not noticed from a patient perspective. Also the hamstring is a soft tissue graft meaning the soft tissue is fastened to the bone and the bone grows into it. The tunnel is permanent and is known for tunnel widening by 'the winshield wiper affect' meaning the graft is slightly narrower then the tunnel and the back and forth movement makes the tunnel drilled for the new graft wider over time... If you were to ever re-tear the hamstring graft the surgeon is limited by the existing tunnel and if it wasn't drilled perfectly or in the exact right spot there are no options but to use the same (possibly widened) tunnel. The other disadvantage is alough possibly unnoticable the graft that they take (flex your hamstring and feel the cord on the back inside of you knee) is removed from behind the knee to damn near you groin (a solid 8-10") of imporant tendon and in clinical studies on cybex machines that hamstring can be 10% weaker due to the loss of that tendon 9that is why this is not that highly recommended for soccer players and other hamstring heave atheletes)...Also, think that the hamstring is the major stabilizer muscle preventing the ACL from tearing in the first place...but it has worked out well for me....
The hamstring is the hardest to revise if retorn...

Patella Autograft:
Bone-tendon-Bone graft...Each bone plug is fastened into the drilled tunnels and fuses to become part of the bone which many think is the most secure connection. The surgeon is limited by the ammount of tendon he can harvest from the middle of your patella as to not comprimise its strength. I hope some people can ring in on this next point...Almost everyone I speak with that has had this graft has had much more issues with their patella tendon years post surgery due to its partial loss (for some it regenerates the middle section better then for others) although the ACL has been great. The thing that worries(d) me about this is long term knee issues related to the patella. I think that extremely aggressive PT and constant biking is extremely important with this option as the only person I know with no patella issues was a rediculous PT madman.
Allograft:
The current trend for allografts is to use a patella tendon. Here you have the bone-tendon-bone option with no donor site issues. My surgeon (and my cousin who is a sugeon) recommends this option and has used it on several US freestyle athletes with excellent results all of which have been able to return to their previous level of performance post-surgery. The advantages of this are no donor site issues and the surgeon can harvest a much fatter graft then he could from your own patella. Disadvantages include disease transmission which is extremely minimal (last known case was in 1988, before many truly realized the implication of diseases such as HIV). possibility will never be zero because it has happened, but is somewhere in the range of 1:5,000,000 at this point. Also irradiation techniques have greatly improved as of late... The graft will be stronger then the old ACl in 3 months post surgery but takes 1-2years to fully vascularize and integrate (slower then an autograft). These have also been thought to stretch a bit due to the irradiation etc. but I have not seen any documentation.

Soooo, I am also in your boat... I feel the patella autograft is probably the best option for the ACL itself, but once that is healed I don't want any issues and i don't want to compromise any other part of my repaired knee (that is why i went with the hamstring the first time, and allografts were not near as common and accepted at that point). Chronic patella pain sounds horrible and there doesn't seem to me many options for that if it was not taken care of in the initial year of PT.
At this point I am leaning towards the Patella Allograft to get the bone-tendon-bone graft without any donor site issues. The doc said if all PT goes well he clears full activity in 4 months. It works well for US team freestylers who are cleared 4 months post op (pretty much the best testing grounds for knee repair tests IMO) so I feel better about the strength and more at ease about the longer vascularization time. (Altagirl has a good pic posted of her revascularized allograft, helping to prove that it does happen!)...

So, who has had a patella autograft and how does your patella feel?

For you my advice is to research the shit out of it, weigh the pluses and minuses, and figure out what you think would be the best in your particular case.

Here is a great resource for exploring all the choices:

[flatlander420]

Tore my ACL and I need to decide on the method of ACL reconstruction. How did you decide of types of procedure? Why did you choose one over the other? What is everyone's thoughts post surgery?

Thanks for your help.

I hate the idea of surgery

I have a hamstring graft in my left knee. I was given all 3 options,hammy ,patella or cadaver.. I didn't want someone else's body parts and a patella graft was not my surgeons preferred method. That left me with hammy. I actually play a lot more soccer than I ski and my doc felt that hammy was the way to go. I trusted her judgment and so far I have had zero problems in returning to soccer and skiing. The first 2 weeks post surgery are somewhat miserable but then PT was actually really fun for me and I enjoyed every minute of it. She released me to start training on grass kicking a ball etc at six months post op exactly. It took me a few more months to regain my confidence, tackling and going in for 50/50 balls. I would say I am at 90% of were I was pre injury,given I am also a year 1/2 older.
Theres tons of info out there, even in this forum........ good luck,have courage and go for it!

[Tele'ndaboat]

My wife has had both hamstring and cadaver. cadaver rocks, they used someones achilles tendon, which is about ten times as strong as the acl and the recovery was about 1/3rd the time. I think the only reason you wouldn't do cadaver is cause it creeps you out. The risks of rejection are minute. Just my $.02. It was amzing to me how much easier the cadaver was on her.

[hemas]

Pick a doc that you trust and who understands what you do... Then go with his suggestion, as he is the one doing the OP and has to be comfortable with the method he's using...

At least, that was how I ended up with my auto-hamstring graft.

[HOBA]

Thanks for the info.

My doctor told me he has done as many of the hamstring as the allograft. So he is comfortable doing either and told me that the choice was up to me.

[Huckwheat]

Here is my short answer, but search for my posts in Gimp Central and I have lots written.

Wife and I both have Allograft (cadavear) and both are psyched on it. I think you have to take it a bit more easy for the first 6 months, but I have had great luck. Skied hard with a brace the first year, and took the brace off at the one year mark. Definately hucked my way throught that year and continue to do so. Also, do 24 hr adventure races and endurance biking, and all feel great on my knee (and I weigh 200+, so not that easy on my body parts).

[Woodlandclown]

my two cents--I am having a hamstring autograft. This is what my dr. recommended and what he had done himself when he tore his. He is a really good Doctor based in Lake Placid who works on World Class athletes frequently. He said that enough studies havnt been done about allografts and long term consequences--not nessesarily rejection, but transmission of "things." I dont have any particular qualms myself about a donor, but i wanted to go with what he recommended and was comfortable with. Havnt had it--so cant comment on how it works though. I know a few people who have had the same surgery with same doc i am using who have had no problems and still charge on the hill.