ACL reconstruction

[XXX-er]

to follow up on this thread I had surgery sept 29/ 2020, so it took almost 9 months in the Canadian system to get surgery during which I could mtn bike but it hurt, so I ended up skipped a ski season, 9 months of not being an idiot to let the surgery heal up and then nothing was firing well the next ski season, I would check in with the PT once month but really it was all bout me getting my ass to the gym so 120 days on the weights

PT said its gona be 3 full years to recover and it was 2.5 yrs post surgery before I could ski rough groomers without pain and i could say to myself " OK this has worked and i can still ski " I think maybe a lot of people go back too soon and wreck the surgery, personaly I was a very good boy so didnt fuck anything up and I would say its now really good but still needs to get stronger


The thing about letting an ACL heal itself is you don't know if its gona heal, you don't know if you will ski again in fact you don't know SFA so I would opt for the surgery

As for a brace the surgeon ( skier who had his acl done ) said " if I did this right you shouldn't need a brace " so I never got one,

[Dantheman]

seems that surgery ain’t the only option anymore…

“A torn ACL can heal itself, new study shows. Surgeons disagree.

The finding that surgery may not be needed for ACL injuries could redefine future treatment and suggests that the knee is more resilient than previously believed”


https://wapo.st/3XvDelP




of course the surgeons disagree.

"Reviewing scans from the first 80 patients for the new study, Filbay and her colleagues noted healing — which they defined as MRI signals indicating tissue was bridging the torn edges — in 90 percent of the knees. None were fully healed, according to a standard, 4-point scale of ACL health, which scores a total tear of the tissue as a zero. But 50 percent now qualified as grade 1 injuries, showing some entwining of the torn ends, 40 percent achieved grade 2, and 10 percent were at grade 3, representing a nearly intact ACL."


I can't say I find that particularly confidence-inspiring, though they are interesting preliminary findings. Needs more follow-up at 6/12/18/24 months since 3 months is pretty short. It does seem plausible that the bracing protocol should be first-line treatment for most ACL tears in people who aren't competitive athletes. If nothing else that will give you a good indication of how compliant patients will be with post-surgical PT if they end up requiring a reconstruction. There's not much point in reconstructing someone's ACL if they're not going to do the post-op PT.

Anecdotally, I've had a ruptured tendon heal spontaneously. I ruptured the EPL tendon in my thumb skiing. Saw a hand ortho who confirmed a full rupture ("Well, that thing's completely gone"). He recommended not operating since I still had shockingly good function. Over the next 6-12 months I was amazed to see it grow back on its own. However, it's not as thick and tight as the EPL on my other hand so there may be limitations to this approach.

[Dexter Rutecki]

to follow up on this thread I had surgery sept 29/ 2020, so it took almost 9 months in the Canadian system to get surgery during which I could mtn bike but it hurt, so I ended up skipped a ski season, 9 months of not being an idiot to let the surgery heal up and then nothing was firing well the next ski season, I would check in with the PT once month but really it was all bout me getting my ass to the gym so 120 days on the weights

PT said its gona be 3 full years to recover and it was 2.5 yrs post surgery before I could ski rough groomers without pain and i could say to myself " OK this has worked and i can still ski " I think maybe a lot of people go back too soon and wreck the surgery, personaly I was a very good boy so didnt fuck anything up and I would say its now really good but still needs to get stronger


The thing about letting an ACL heal itself is you don't know if its gona heal, you don't know if you will ski again in fact you don't know SFA so I would opt for the surgery

As for a brace the surgeon ( skier who had his acl done ) said " if I did this right you shouldn't need a brace " so I never got one,

Timeline sounds really odd to me...did you have a lot of other damage? 3x ACL reconstruction for me, six months is the longest it's ever taken me to be back to skiing, and it was probably a week or two (at the outside) after the six months before I was skiing again at essentially 100% of pre-injury (and while the second two injuries were almost entirely just the ligament and some meniscus damage, the first one featured some other nastiness--shattered condyles and such). I really thought that 6-9 months of solid PT was the accepted amount of time before return to activity--I've heard that it can be a year+ before the new ligament returns to what might be considered full strength, but my surgeons/PT's never made me wait that long.

I only really wore a brace following the first reconstruction, for maybe a few months. It sucked and I don't think helped me at all--received a better brace after the third one, it sucked a little less but I ditched that one too pretty quickly. The fact that neither brace worked well with the top of my ski boot certainly didn't help, but I'm extremely skeptical that at least for my injuries any brace would have had a meaningful effect (IMO braces might help prevent other kinds of knee injuries but probably don't do much for your ACL--I'm not an ortho and don't even have Holiday Inn credentials, so don't take that as advice or anything, but I do recall reading some expert opinion that questioned effectiveness of braces at helping prevent ACL injury).

[XXX-er]

The surgeon actualy said from looking at the MRI I have a great knee joint other than the ACL was completely seperated, he said that he used a brace his first year back skiing and he didnt think I would need one


first time skiing at about 15 months was so bad I almost gave up skiing, I wonder if the leg just deteriorated more with all the waiting in the Canadian system and old age doesnt help

[MagnificentUnicorn]

You could have worn a brace and kept up with your activity and you wouldn’t have had as much wasting. A friend of mine blew her acl halfway through the season and kept skiing with a brace until the season was over. I know it’s anecdotal but so is every post in this thread.


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[XXX-er]

I got a friend who blew her knee same time as me, she has had the MRI/ done a consult with the same surgeon so its just a matter of her not being a chicken and booking the surgery , instead she is still ski coaching with a Donjoy brace and she sez it doesnt hurt

So i know this now but i didnt know it then, acess to sports med is not so great up here but also i blew it right at the beginning of Covid lockdown so not only was there was no skiing

there was no nothing

probably the worst possible time to be kacking an ACL,

[PowerWhore7]

Timeline sounds really odd to me...did you have a lot of other damage? 3x ACL reconstruction for me, six months is the longest it's ever taken me to be back to skiing, and it was probably a week or two (at the outside) after the six months before I was skiing again at essentially 100% of pre-injury (and while the second two injuries were almost entirely just the ligament and some meniscus damage, the first one featured some other nastiness--shattered condyles and such). I really thought that 6-9 months of solid PT was the accepted amount of time before return to activity--I've heard that it can be a year+ before the new ligament returns to what might be considered full strength, but my surgeons/PT's never made me wait that long.

I only really wore a brace following the first reconstruction, for maybe a few months. It sucked and I don't think helped me at all--received a better brace after the third one, it sucked a little less but I ditched that one too pretty quickly. The fact that neither brace worked well with the top of my ski boot certainly didn't help, but I'm extremely skeptical that at least for my injuries any brace would have had a meaningful effect (IMO braces might help prevent other kinds of knee injuries but probably don't do much for your ACL--I'm not an ortho and don't even have Holiday Inn credentials, so don't take that as advice or anything, but I do recall reading some expert opinion that questioned effectiveness of braces at helping prevent ACL injury).

Sounds like you're in the know so I'll ask my question & hopefully you see this....

Wife blew her ACL and a lateral meniscus tear, what is your opinion on donor vs patella graft? thank you in advance.

[bodywhomper]

There’s a more active acl injury thread.

ACL Class of 2017
https://www.tetongravity.com/forums/...d.php?t=309811

Donjoy makes a lot of clinical-based claims about the support that their fancy braces provide. https://www.djoglobal.com/our-brands/donjoy/acl-bracing

[gregL]

Wife blew her ACL and a lateral meniscus tear, what is your opinion on donor vs patella graft? thank you in advance.

My surgeon, who's done a lot of them, says the vast majority of "repairs" he does are donor grafts, the strongest option by far is patellar tendon bone-to-bone. He used to be the team physician for the San Diego Chargers, FWIW. Hamstring was his #2 option.

[pfluffenmeister]

I've had two hamstring autografts and have good outcomes.

My cutter said that pateller autografts have patients reporting more pain the joint after recovery vs. that of a hamstring autograft.

But I just break 'em

PS Annoyingly, every time I type in autograft I have to override the damn phone which thinks it knows what I'm trying to say.

[MagnificentUnicorn]

Professional sports team doctors pay for the privilege of being a team doctor. Take that as you will.

Bone tendon bone acl grafts have a much smaller cross section than a hamstring autograft or a quad tendon allograft.

All grafts have initial good strength but it’s during the remodeling phase weeks after surgery when they are weakest and most vulnerable.

There is some weakness reported after hamstring autograph but there is evidence that hamstrings regenerate.

Most pain from patellar tendon autograph is associated with the donor sites on the patella and tibial tuberosity.




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[Duffman]

Sounds like you're in the know so I'll ask my question & hopefully you see this....

Wife blew her ACL and a lateral meniscus tear, what is your opinion on donor vs patella graft? thank you in advance.

Wife is 45 and prehabing now, she has minimal symptoms now but there is enough laxity that she's gonna need the surgery. Well regarded female Ortho here who does a to of women athletes recommends Quad tendon , her reasoning is that the retear rate is lower than donor graft, she can get a bigger stronger graft than a hammy, and that possible hammy weakness post op is more problematic than the quad b/c quad dominance and weak hamstrings are a contributor to ACL injuries.

She also said for high level younger athletes she recommends the bone to bone patellar graft bc it's the absolute strongest one, but that it has significantly more annoying symptoms going forward (pain squatting on knee, kneecap pain, etc)

[mcski]

Duff, That’s a good run down. Funny how quickly this all evolves. A decade or 2 ago, seemed like donor grafts were the popular option because they were the ones perceived to be stronger.

The quad theory makes sense. First I’ve heard of that option though.

[Duffman]

Duff, That’s a good run down. Funny how quickly this all evolves. A decade or 2 ago, seemed like donor grafts were the popular option because they were the ones perceived to be stronger.

The quad theory makes sense. First I’ve heard of that option though.

My impression is all the grafts have pros and cons, and a successful reconstruction can be done many different ways. Best bet is to find a surgeon with a good track record and discuss why they pick the method they prefer to use.

[yeahman]

The biggest advantage to a donor graft that I can see is no residual compromise in the strength of the hamstring or quad. I had hammy and for me it is noticeable. It doesn't affect anything I do, but it's still noticeable. If I did it again I would consider donor for that reason, even if it means greater risk of failure in later years.

One thing I am very grateful for is no lingering pain or arthritis, as seems to be more common with the patellar graft. I absolutely did not want to risk knee arthritis.

[LongShortLong]

Link discussing alternate approach to ACL surgery using bovine collagen and patient's own blood, being studied at some sites (in 2020)
"Pioneered by Dr. Martha Murray, orthopedic surgeon-in-chief at Boston Children’s Hospital, the BEAR procedure has shown such promising early results that the FDA authorized its marketing in late 2020."

https://www.uchealth.org/today/acl-t...urn-to-sports/