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trreid

Wrecked Knee

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trreid

...ruptured ACL, torn meniscus, strained MCL = surgery + 6-12 mos. rehab.

Love to say it happened while going for a PB in the course, but this was run-of-the-mill weekend stupidity- stepped off a ladder wrong (missed the last rung) & heel planted while the rest of me rotated nicely around my left knee. Something had to give.

Working with a good local sports medicine guy- he presented me with some options for reconstructing the ACL- using patellar tendon, hamstring, or cadaver tissue (ugh?!). Different advantages/disadvantages & rehab. Anyone who's been thru this & has any advice on what type of ACL repair you had & how the results are after time- greatly appreciate.

Lots of time to read responses...

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jgouveia3

i've had ACL repair twice, 4 total ops on the same knee (2 complete reconstructs, 2 clean outs).

first time was in '87. they use a synthetic material back then (something like catgut??). It didn't last too long. I blew it out again in '02 (I think), and new ortho doctor said that whoever the hack who did it the first time, didn't know what he was doing (and the guy who did it the first time was the doctor for the NE Patrioits). he said that it looked like it had been torn apart again for quite awhile, and the last injury was just showing that it really was damaged again, and it had been for awhile.

this time they did the hamstring. Full recovery was about 8 months (I was ice skating and water skiing earlier than that, but not at full speed). I am pretty much back to 100%, although I have arthritis, as is expected. I do everything I used to, but wear a full knee brace all the time for Hockey and Volleyball. Water skiiing doesn't really bother it at all. the brace is psychilogical. After the first I wore it about a year, then threw it out. Now i were it all the time, thinking that maybe i wouldn't have blown it out again if i was still wearing it.

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Stevesher

Tore ACL in 98 from football. The Doc used part of my hamstring for the repair. My understanding is that they roll the muscle like it's playdow (sp), then they use it as a ligament. It lasted 2 years. I fell down some stairs and re-tore it this time with a bonus! A torn meniscus. I had the surgery again, this time with a patellar tendon to replace the ACL. I have been active with it, I can do most things. I avoid basketball and I don't play football. I still wakeboard and after a weekend it does get sore, but nothing major. I have taken glucosomine/controntant pills twice a day. The spelling, I am sure is wrong, but you can purchase it at any grocery store. Make sure you look at the amount of mg in each pill to get the most out of each one. I always wear my knee brace when wakeboarding. I actually had it custom made from CTi2. It will run about $1500.00, but my insurance covered it. Make sure you do your exercises to strengthen your leg and keep trying to bend it, not to lose any range of motion. I actively workout and always do at least one day of legs to keep my mucles strong.

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JohnDoe

2 ACL reconstructs here (both knees).

I went with the patellar graft. As it was described to me, the hamstring has the shortest layoff, but is the weakest long term material. An allen graft can be OK, but, can be weak down the road, and you can have rejection problems. The patellar graft is the strongest, but is by far the most invasive, painful, and longest layoff. However, for me, I thought it was worth it to get the strongest long term repair. Tendonitis is an issue, but not bad yet. You''ll be OK, just work hard, keep your chin up, and use the time to become a certified driver!

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TOAST

yaaaouch. . . .sorry to hear it.

I was diagnosed the same as you after my own stupid accident. (trampoline - better off to keep legs on the tampoline or off, but don't stick one through the springs and then fall over the rail)

The doc decided to scope it first, before going in for reconstruction and it turned out there was much less damaged than originally diagnosed.

My rehab/PT was done by an attrative grad student -- I actually looked fwd to the PT visits. PT went very well and my knee/legs came out even stronger than I went in. (but I didn't get the full ACL reconstruct so I can't speak to the options you're asking about)

Good luck with your recovery-- get the very best care you can find.

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trreid
Sorry to hear that Todd.

I guess you won't be joining us in August then?

Get better.

Thanks Bill, probably no go for Coble's- at this point I have surgery scheduled for the second week of June- even aggressive rehab would only have me as a gimpy spectator by August.

Maybe I can get insurance to pick up ski school next spring as part of my PT...

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DUKENO1

Very sorry to hear about your injury. I have never hurt my knees (knock on wood) but have a good friend who tore his several years ago. He was very active prior to the injury...barefooter, skier, wakeboarder, mountain biker and snow skier(thats how he hurt his). He went with the patella tendon. He still has weakness and soreness all the time and he says he was diligent with his phys therapy and knowing him, I believe him. They basically take a chisel and crack open your knee to get to the patella tendon. So not only does your original tears have to heal but also the damage done by the procedure. He swears that if he could do over he would go with the cadaver tendon. He said he has talked to others that have went that route and had great success. Obviously I am relaying second hand info and if I am giving any bad info let those who know better chime in and I will stand corrected.

Good luck with your healing

Tim

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Toby

i would go with the hamstring option personally. using the patella tendon (the tendon between the patella and tibia) will weaken it to a certain degree and have perminant change. using a dead mans tissue will mean you will may be on anti rejection drugs the rest of your life.

muscle heals. by the time you will be begining rehab you probably wont even know you had it taken out of your leg. but what john doe said is also true on it being the weakest.

trust your surgeon

just my 2c...

best of luck with it.

Edited by Toby

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trreid

Thanks, everyone for the excellent feedback & encouragement- everything jibes with what my Dr. told me- so at least I'm feeling good about his advice & approach. Have a few weeks of pre-op rehab to work on before my surgery, so I'll think on it- for me it's between the patellar & hamstring.

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UWSkier

Real sorry to hear about that.

FWIW, my dad's a doctor and when he blew his ACL in a snowmobile wreck 2 years ago, he decided along with the doc for the GB Packers to go with the cadaver tissue for the repair.

Of course, now he's having these haunting nightmare's from this other guy's life... Crazy.gif

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auto

I am thinking my last two weekends have partially torn my meniscus, landed the same way twice, Mad.gif I will see how it feels this weekend Biggrin.gif

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NorCaliBu

I had my ACL replaced with Patellar Tendon. Harvesting the tendon tissue doesn't require any "cracking" of the knee. They cut open the front of your knee, remove the middle 1/3 of the tendon, and then stitch the gap closed. The tendon is living tissue and will heal (regrow) so eventually it will be whole again. This was the method recommended by my ortho.

Rehab is where the difference in recovery comes in. I've heard others claim that they stuck to the rehab "plan" but still had problems. To be honest, the rehab "plan" is set for the lowest common denominator. Get the CPM (Constant Passive Motion) machine and use it from day one. It will keep the leg from tightening up and allow you to progress in you PT much faster. My first week after surgery I was strapped to that machine 24/7. One week post-op I had extension to 2* and flexion (sp?) to 112*. Three weeks post-op I was back on my road bike (on a trainer) and at 5 weeks I was back riding on the road. I went to PT 3 times week starting 1 week post op and pushed things as hard as they would let me. I am now 2 years post-op and have no pain, no swelling, and I ride my road bike in the Sierra's on rides sometimes exceeding 100 miles with no knee problems (breathing is a different story :lol: )

I've got to go eat dinner. I'll post a little more later tonight.

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every doc does it different, most everyone i board with has had it done, ones that go with Patellar seem to have less pain and more solid than the hamstring crowd. Some people get CPM, some people start rehab the day after surgery. The thing I can't stress enough is go to a sports med doc that specializes in Knees. :)

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89SN2001

Been there too - from my first attemp at wakeboarding - just a little too soon after my 2nd was born.

Sorry it happened to you. And off a ladder. Somehow that makes it worse than if you did it skiing. As said, get a good Sports Med Doc and sports med trainer for rehab. They go about things a little more aggressively when they know your not just there to feel better.

Best of Luck.

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NorCaliBu
every doc does it different, most everyone i board with has had it done, ones that go with Patellar seem to have less pain and more solid than the hamstring crowd. Some people get CPM, some people start rehab the day after surgery. The thing I can't stress enough is go to a sports med doc that specializes in Knees. :)
Absolutely. I drove up to Truckee (near Tahoe) to have a knee specialist do mine. I went to an "Athlete Oriented" PT as well.

My ortho said that the patellar tendon method is the preferred method for people who are looking to be very active after surgery. It is definitely more invasive and to be honest...the most pain post-op came from where they removed the graft. As I recall cadaver & hamstring methods allowed for PT sooner post-op but had issues with tissue rejection (with cadaver) and tissue stretching too much (with hamstring).

The worst was when they pulled the staples out down the front of the knee... Cry.gif ...I have a really high threshold for pain but boy did that hurt... Shocking.gif

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Absolutely. I drove up to Truckee (near Tahoe) to have a knee specialist do mine. I went to an "Athlete Oriented" PT as well.

Another key, that they understand the importance of sports. The knee doc I was referrin to was an All American LB at Tulane, the guy that did my shoulder (also in his office) played professional baseball. I have been too all sorts of orthos and the former or current athletes seem to care the most, be passionate, and understand the importance of your activity. :)

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trreid

Update- had my surgery 4 weeks ago- went with the patellar tendon graft for the ACL- and it turned out that I had done more damage than they originally thought. Also did a complex meniscus repair (tacked back together in 2 places). Then 4 weeks of extremely limited activity until the meniscus heals- no weight on leg, full brace, limited range of motion.

Dr just cleared me yesterday to push the therapy, so now the fun begins. With any luck I'll be back behind the boat by the spring. Amazing how much a leg can shrink in 4 weeks.

Not a moment too soon- by this past weekend I was ready to throw the crutches thru the window. Still managed to drive the boat last week, but it was like a slapstick routine watching me get in & out from the dock. Kind of a combination butt-slide, leg lift, & drunken stagger around the engine box & into the drivers seat. Kids got a laugh- me, not so much.

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Update- had my surgery 4 weeks ago- went with the patellar tendon graft for the ACL- and it turned out that I had done more damage than they originally thought. Also did a complex meniscus repair (tacked back together in 2 places). Then 4 weeks of extremely limited activity until the meniscus heals- no weight on leg, full brace, limited range of motion.

Dr just cleared me yesterday to push the therapy, so now the fun begins. With any luck I'll be back behind the boat by the spring. Amazing how much a leg can shrink in 4 weeks.

Not a moment too soon- by this past weekend I was ready to throw the crutches thru the window. Still managed to drive the boat last week, but it was like a slapstick routine watching me get in & out from the dock. Kind of a combination butt-slide, leg lift, & drunken stagger around the engine box & into the drivers seat. Kids got a laugh- me, not so much.

Congrats, and push hard during hard during rehab, it will get you back sonner :)

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Update- had my surgery 4 weeks ago- went with the patellar tendon graft for the ACL- and it turned out that I had done more damage than they originally thought. Also did a complex meniscus repair (tacked back together in 2 places). Then 4 weeks of extremely limited activity until the meniscus heals- no weight on leg, full brace, limited range of motion.

Dr just cleared me yesterday to push the therapy, so now the fun begins. With any luck I'll be back behind the boat by the spring. Amazing how much a leg can shrink in 4 weeks.

Not a moment too soon- by this past weekend I was ready to throw the crutches thru the window. Still managed to drive the boat last week, but it was like a slapstick routine watching me get in & out from the dock. Kind of a combination butt-slide, leg lift, & drunken stagger around the engine box & into the drivers seat. Kids got a laugh- me, not so much.

Good on ya! Take it easy but do at least what they are asking and a little more if you can stand it. I had some more of my menscus removed on the 13th and am almost recovered enough to get back on the water after being off the water for several weeks. The bad news was the Doc painted a bleak picture for me after looking at my knee. My ACL and MCL look great, it's just that there isn't much cartlige left.

Reading some of the stories gives me hope of being able to continue skiing, thanks.

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trreid
Good on ya! Take it easy but do at least what they are asking and a little more if you can stand it. I had some more of my menscus removed on the 13th and am almost recovered enough to get back on the water after being off the water for several weeks. The bad news was the Doc painted a bleak picture for me after looking at my knee. My ACL and MCL look great, it's just that there isn't much cartlige left.

Reading some of the stories gives me hope of being able to continue skiing, thanks.

Thanks! that's the approach I'm taking, and though patience isn't one of my virtues, I'm learning. If it's any consolation, the meniscus repair is what's driving the slow rehab for me- if he had removed it instead of repaired it I'd be back on the water much sooner- as it is now I'm looking at 7-12 months if all goes well. Apparently there's not much blood flow to the meniscus, and repairs are touchy.

I know there are some new treatments for the cartilage loss- and my doc told me there are some promising developments in meniscus replacements/transplants- they are doing them in 20-something athletes who can't afford early onset of arthritis. He thinks that in 5 years or so they may have some options for those of us a little further on the age/activity curve. Hopefully we can get by 'til then!

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Thanks! that's the approach I'm taking, and though patience isn't one of my virtues, I'm learning. If it's any consolation, the meniscus repair is what's driving the slow rehab for me- if he had removed it instead of repaired it I'd be back on the water much sooner- as it is now I'm looking at 7-12 months if all goes well. Apparently there's not much blood flow to the meniscus, and repairs are touchy.

I know there are some new treatments for the cartilage loss- and my doc told me there are some promising developments in meniscus replacements/transplants- they are doing them in 20-something athletes who can't afford early onset of arthritis. He thinks that in 5 years or so they may have some options for those of us a little further on the age/activity curve. Hopefully we can get by 'til then!

That's me you're talking about here. About 12 years ago some hack got into my knee and tried to "reapair" my meniscus and I woke up from the procedure to 8 wks non-weight bearing. I had to do it so I did, after the crutches were gone, and all muscle, I started re-hab and that was grueling, hard, painful work. Spring came and I started to ski only that repaired knee hurt like the dickens. After two months of gritting my teeth through the pain I went to a different doc. One who travelled with the US olympic team and he went into my knee again and fixed me up. His conclusion was that the original guy didn't make a very good call and that procedure was doomed to failure from the start. Now, I've got severe arthritis and that's my biggest problem. I dont' hurt now but, my knee's future is limited.

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trreid
That's me you're talking about here. About 12 years ago some hack got into my knee and tried to "reapair" my meniscus and I woke up from the procedure to 8 wks non-weight bearing. I had to do it so I did, after the crutches were gone, and all muscle, I started re-hab and that was grueling, hard, painful work. Spring came and I started to ski only that repaired knee hurt like the dickens. After two months of gritting my teeth through the pain I went to a different doc. One who travelled with the US olympic team and he went into my knee again and fixed me up. His conclusion was that the original guy didn't make a very good call and that procedure was doomed to failure from the start. Now, I've got severe arthritis and that's my biggest problem. I dont' hurt now but, my knee's future is limited.

Ugh! Here's hoping that 12 years of advances (& a good doc) get me better results by this spring. And that your arthritis stays at bay for a long time.

Some perverse consolation- Lucky Lowe just won the last Big Dawg qualifier- 2 years after full hip replacement... hope for us yet.

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That's me you're talking about here. About 12 years ago some hack got into my knee and tried to "reapair" my meniscus and I woke up from the procedure to 8 wks non-weight bearing. I had to do it so I did, after the crutches were gone, and all muscle, I started re-hab and that was grueling, hard, painful work. Spring came and I started to ski only that repaired knee hurt like the dickens. After two months of gritting my teeth through the pain I went to a different doc. One who travelled with the US olympic team and he went into my knee again and fixed me up. His conclusion was that the original guy didn't make a very good call and that procedure was doomed to failure from the start. Now, I've got severe arthritis and that's my biggest problem. I dont' hurt now but, my knee's future is limited.

Ugh! Here's hoping that 12 years of advances (& a good doc) get me better results by this spring. And that your arthritis stays at bay for a long time.

Some perverse consolation- Lucky Lowe just won the last Big Dawg qualifier- 2 years after full hip replacement... hope for us yet.

Got to ski this weekend and started off very easy just to see how things would go. I made all my deep water starts and quickly progressed through 34mph/32off from 32mph/28 off. After skiing 6 sets I'm back into 35 off and making 50% of them. My timing seems to have suffered the most and now that my knee is feeling good I'm getting down too hard against the boat. What a blast though! Very glad to be skiing again. I get a little swelling after a couple sets and my whole bodies stamina is down but I'll have to keep skiing to build that back.

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