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  1. #1
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    Young athlete ACL reconstruction - which graft

    Just learned my 16 y.o. daughter is gonna need the full meal deal. Pediatric Ortho doc says he likes the quad graft. PT buddy has concerns about the muscle. Hamstring graft has issues. Cadaver graft might not have the strength of a live graft. Anyone have any experience with younger athletes?
    Let me lock in the system at Warp 2
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  2. #2
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    My daughter went through this a about 10 years ago. She played high school basketball and was pretty good. Had a chance of playing college ball. During a summer tournament game she set a screen and had a girl twice her size trip and fall into her while she had her leg extended. Had ACL, MCL and meniscus repaired. Our ortho recommended the cadaver graft. She was out for almost a year if I remember correctly. She never came back to her previous level of performance. Its not that she didn't try. She worked incredibly hard. Her shot came back. 92% free through shooter and 45% percent from three. She just seemed like she lost a step. Her quickness was down and she just didn't seem to have the first explosive step and was a bit tentative. May have been psychological, but things were never the same.

    Personally I think it worked out for the best. After being hurt she was able to concentrate on academics more. She just finished up a a double major in Biology and Chemistry with a minor in Psychology and had scholarships that paid everything. Starting a master in the fall with plans to go on to med school when she gets the MCAT taken.

    Good luck with everything. I hope everything works out with your daughter. It can seem devastating at them time but things work out.
    I'd rather die while I'm living then live while I'm dead

  3. #3
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    any way you cut it ( literaly ) ACL reconstruction by the textbook and IME is 9 months,

    Tissue trendon only dies and regrows so fast so you can't just man up and work harder to recover sooner

    if you rush it you will be doing it again
    Lee Lau - xxx-er is the laziest Asian canuck I know

  4. #4
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    I believe b-p-b autograft is the go-to for young athletes (this and other studies seem to support that https://www.healio.com/news/orthoped...young-athletes), and it seems worthwhile to look into this as well:
    https://www.sciencedaily.com/release...0521124544.htm
    [quote][//quote]

  5. #5
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    I just had mine done with b-p-b. Doc said he generally prefers the hamstring graft but recommended the patellar in my situation. I am younger (27), was a national-level runner in college (D3), and was still competing in various events (tris, trail events, etc.) at the time of the injury. Doc thought the b-p-b was my best chance of getting back to that level post-op

  6. #6
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    Thanks guys
    Let me lock in the system at Warp 2
    Push it on into systematic overdrive
    You know what to do

  7. #7
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    I went hamstring graft around age 20 and that knee has been very solid. I was skiing hard the following season, but it took a while longer to get in a catchers stance comfortably.

  8. #8
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    There is no wrong choice for most situations as far as grafts go. I'd tend to stay away from all-graft with younger athletes. Double bundle hamstring and quad tendon are both solid choices for teenagers. There really is no wrong just pluses and minuses to each. In the end you may end up deferring to what your surgeon is comfortable with and is good at and if you aren't happy with that there is nothing wrong with a second or even third opinion.
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  9. #9
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    I think there's something to be said for not permanently weakening the hamstring or quad at such a young age. Although cadaver graft has a higher fail rate over the course of like 20 years, it does have the advantages of 1) not weakening the quad or hamstring; 2) quicker rehab/recovery; 3) not likely to cause arthritis or aches and pains like a patellar graft can. Worst case scenario is it fails at some point and needs to be done again. But it might not fail, in fact odds are it won't.

    I had hamstring graft at age 50, and while I think it was the right decision for me, I do notice the 10-15% decline in hamstring strength on that side, and I'm not sure it's ever really possible to get back to 100%. Doesn't really affect me but for a young athlete it might make a difference.

    Yeah, tough decision, lots of pros and cons no matter what way you go.

  10. #10
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    I had double bundle hammy on my R knee when I was 19. I got 30yrs of hard service on that one before it fell apart. Did my left one with the same at 25 and got 12yrs out of it.

    The allograft I had at 37 was damn near painless, off meds and began weight bearing by day 3, was able to pass the USST return to sport protocol at 6months and felt as strong as I'd been in a while. The graft failed at 8months, and took out some meniscus that I have dearly missed since, had to go bpb for #3 on that knee.

    The recovery times will vary depending on how well you heal, fitness going in, etc but ultimately the allograft requires a lot more patience, 12-18 mos instead of 6-12 that are possible with harvesting your own tissue.
    Move upside and let the man go through...

  11. #11
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    Just out of curiosity what were you doing when the allograft failed at 8 months?

  12. #12
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    Have you read this? Interesting stuff:
    https://www.howardluksmd.com/orthope...pinion-series/
    A society that puts equality before freedom will get neither. A society that puts freedom before equality will get a high degree of both.
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  13. #13
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    Good video. I hadn't seen someone lay all the options out so succinctly before

  14. #14
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    Is she scheduled?

    bpb graft 6 months ago here, my surgeon recommended based on activity profile - 43 and trying to ski like a 23 year old. Said that was his go to for anyone with a higher activity profile.
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