one ACL down - doc referrals?

[britney]

hey dex - anything you've got on the quad procedure would be very interesting.

from what i know so far,

the PT graft is most painful and hard to recover from. i am not afraid of that, but i am concerned by the potential never to be able to kneel normally again, and the risk of stress fractures (like Jerry Rice had)

the allograft is weakest and has risk (although low - 1 in 1.5 million) of HIV or hepatitis infection.

the hamstring graft sounds OK in general, but for me, it poses a problem - i have had tendonitis in that tendon and am concerned that (1) the tendon is too weak and puny to be used, or (2) that they will think it's OK to use (i.e., take 2 of the 4 strands of hammy tendon to use as ACL) but then afterwards i will have chronic tendonitis in the remaining hammy tendon when i try to run.

so i am very curious about the new quad tendon procedure.
-b

[Dexter Rutecki]

http://www.nsosmc.com.au/pinczewski_...kiAJSM2002.pdf

www.aclsolutions.com/surgery

www.highbeam.com/library/doc0.

www.isakos.com/innovations/graftchoice.html

http://www.execulink.com/~frind/Knee...AJSM-Sep00.htm

www.knee1.com/community/forums30.cfm

www.carletonsportsmed.com/graftacl.htm

http://www.wbcarrellclinic.com/14x/1...aftchoices.htm



The first one here I actually haven't seen, but I believe it's the results of a study comparing grafts (I can't open PDFs for some reason). At this point I can't remember one from the other on the rest of these, but there's definitely some good stuff in there.

One other general recommendation I'd make, just because it's what I followed, is to more or less ignore the doc's bedside manner. Hopefully it'll be good and you won't have to, but in picking a surgeon I really didn't care if the guy was chatty or not. I'm pretty good in making sure I get answers to questions, and make sure to know what I want to ask before seeing the doc, so the fact that both my knee surgeons have been somewhat gruff and/or quick didn't bother me, but I can see how some people wouldn't like it. Nevertheless, I'd go with the guy who's the best cutter over a nice guy who'll sit and talk to you for a long time. Of course you always want to avoid 'cowboy' types who just like to do surgery, but since you basically know surgery is a definite that's probably less of a concern.
Hope the links give you decent info.

[britney]

Those links were invaluable! Thanks a lot, Dex.

I confirmed MRI reports today, and the good news is it is JUST the ACL - meniscus and other ligaments look OK.

The bad news is, it could be up to 6 weeks before I can even get cut, and this starts to encroach on next season. But I am doing my PT exercises to [hopefully] get ready for surgery sooner (need full range of motion back before they will operate).

The depressing news is, PT confirmed that after only 7 days, I had lost 2 cm of muscle in my quad! Atrophy sucks! especially after training your legs for years (my x-ray tech put it more bluntly - "your legs are like a 6-pack for abs - but after your surgery it's all gonna be GONE!" gee, thanks.) I'm afraid it is gonna get a lot worse before it gets better...
-b

[divegirl]

Awww, Brit, that's too bad.
Let's hope you can get into surgery sooner.
Crossing my fingers!
-Linds

[Dexter Rutecki]

Yeah, the atrophy sucks, Brit. Mine wasn't too bad before the surgery because I was able to start PT a day after injury, but my leg looks tiny now. Having gone through it before, I can tell you it will come back. The problem is that after surgery you're very limited for awhile in what you can do with the leg, and for much of the day it's in a virtual cast (right after surgery you don't even want to do anything with it anyway).
I had to wait at least 21 days for my surgery, which was the minimum according to my doc. Due to scheduling it took a little longer than that. He only specified at least 90 degrees flexion and full extension, but by the time I was cut it was over 130 degrees. Be sure to get the CPM machine for after surgery if you can, as it seems to have made a huge difference with me in getting ROM back (I'm over 130 again 5+ weeks post-op, much better than last time at this point from what I remember).
Keep at it.

[britney]

my 3-weeks-post-injury-update:

i am supposedly ready to go for surgery, but doc has no time till may 27.

in my [extended] pre-op world, the advice has been regain ROM, and then start strengthening, esp the quad. [everything should be as strong as possible before surgery, but quad in particular will atrophy post-op]

i am going with the allo-graft, fyi. my doc is great! dr. lesley anderson in SF.

the good news about the allograft - faster recovery, and less unsightly scarring! it is just as strong as the autographs, and plenty of professional athletes get it (especially if they have to be back in their sport really fast) - so my doc disagrees with a few comments above that said allografts are weak and not for young people or serious athletes - thats false.

the only problems are fixation to the bone and risk (although low) of infection from the cadaveor tissue. my doc would generally do a hammy graft for someone my age, but i said my hamstring tendon is already a weak point, and i want the allograft. she said fine, and that's what she would get for herself too.

as for how im doing, someone told me the hardest part psychologically is the pre-op time, because you are in limbo. limited in your activities, but not really "recovering" yet. i havent seen the post-op world, but so far this advice seems true. waiting for the docs surgical calendar to open up SUX!

the good news is im pretty mobile for now. doing exercise bike and leg strengthening. and mr. britney had the genius idea of a tandem sea kayak for [upper body only] summer exercise while im recovering! so i'm making the best of it, i guess.

thanks for all the grrrrreat advice! you guys are the best.
-b

[Arnold Babar]

Looks like you and I are in about the same boat (just figuratively, not lookin' ta take Mr. Britney's place in the kayak). I too am looking at early June surgery. I'm still in ROM mode, but I'm itching to get to the strengthening phase. I think I'm going to go the hammy route, though. That cadaver thing just freaks me out. Best of luck with everything. All the posts on this thread were super informative.