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NFT: ACL surgery

lpdcan28 : 11/8/2019 8:47 am
for those that have had it i had some questions. hurt mine years ago and the dr. decided to let it heal on its own since was partial tear. he just fixed the cartilage. its never felt the same since. and a physical exam seems to indicate it never healed. an mri is next.

did they use a tendon from your body or a cadaver? i hear the latter is a quicker recovery.

how long did you need crutches or until it was a lot easier to move around?

did you do your own pt or had to go to a clinic?

any advice/experiences would be great. thanks!
A few answers  
ImThatGuy : 11/8/2019 8:58 am : link
own tendon vs cadaver - when my ACL was repaired they used my own tendon (take it from the hamstring). I've heard a cadaver the recovery is longer actually. Had mine repaired years ago and for the most part no issues, however my thigh (where they took the donor hamstring) is 2cm smaller in diameter, but I'm still pretty active (running, sports etc)

Crutches after - you'll be in pain, take your time but I was able to "walk" in less than two weeks

Own PT vs Clinic - 100% go to a physical therapist don't do it on your own. And the harder you work during PT the easier recovery and better it'll be overall.
did it 2007  
jestersdead : 11/8/2019 8:59 am : link
Used my patellar tendon as that was recommended by the doctor at HSS. Had the options of hamstring, patellar or cadaver.

Did PT at a local clinic
RE: A few answers  
mfsd : 11/8/2019 9:10 am : link
In comment 14668971 ImThatGuy said:
Quote:
own tendon vs cadaver - when my ACL was repaired they used my own tendon (take it from the hamstring). I've heard a cadaver the recovery is longer actually. Had mine repaired years ago and for the most part no issues, however my thigh (where they took the donor hamstring) is 2cm smaller in diameter, but I'm still pretty active (running, sports etc)

Crutches after - you'll be in pain, take your time but I was able to "walk" in less than two weeks

Own PT vs Clinic - 100% go to a physical therapist don't do it on your own. And the harder you work during PT the easier recovery and better it'll be overall.


Very similar to my experience. Tore my right ACL in 2002...did 3 months rehab to strengthen the leg, then had surgery...hamstring tendon too.

Rehab was tough...had I the chance to do it again, I would do more flexibility/mobility stuff than I did at the time. I 100% agree about finding a good PT...that way you will rehab harder than you might otherwise.

I've never had issues with my knee since and have played a variety of sports and done a variety of races. Admittedly, I've had more issues with the hamstring at times, but nothing that's shelved me for too long.

I've been able to be healthy and active mostly without issue for almost 18 years now. For me surgery/rehab was well worth it
Haven't had one personally....  
Kanavis : 11/8/2019 9:22 am : link
But did work with a bunch as a physical therapist a while back.

Cadaver is a little quicker for recovery in my experience but has a higher failure rate (or at least it did back then). I would probably go autograft (your own). As for patellar versus hamstring....there are tradeoffs. Pateller was more common and the standard. But they do take a third of the tendon and some bone with it so anterior knee pain is a common complication. The hamstring is also a crucial muscle and acts as a secondary restraint for anterior knee translation (the acls main job). It also provides proprioceptive input which is impaired after surgery. But all procedures will impair this. I don't know of the implications of the hamstring graft are as well documented but there is a lot written about it I am guessing.

As for home rehab....dont. Go to a good PT. It can make all the difference. You will walk into surgery on your own. When you are done it will feel like you got hit by a truck for a couple of days. Recovery proceeds quickly.. But having experienced hands to guide and answer questions is helpful. If you are in the city go to the NYU center for musculoskeletal care or HSS if you can. I am biased and not practicing right now...so this is just my two cents.
ACL surgery  
Mike in NY : 11/8/2019 9:40 am : link
I have not had it, but I know plenty of people who have had it done. If you are young I would avoid cadaver tendon because the failure rate is higher and that outweighs any difference in recovery time. For PT definitely go to a clinic that specializes in this because most people, while they think it, are not disciplined enough to do the necessary PT on their own. Finally, don't just go to a place or doctor because he/she/it has a big name. Find out from your doctors or doctor friends who they would want operating on their ACL. If there are few names that come up consult with them all and see who you feel the most comfortable with. That last bit applies to any medical or surgical treatment. I have seen people screwed up longterm because they went to the big name doctor or facility and received shoddy work.
Had mine about 5 years ago at HSS  
Everyone Relax : 11/8/2019 10:23 am : link
Used my patella tendon. I think they say patella tendon is the strongest replacement, followed by the hamstring, although the recover is the worst. It all depends on what you want to get back to doing.

I wanted to play basketball again so I went with the option that most athletes do when they have ACL reconstruction. I did PT 2/3 times a week for almost 6 months, it wasn't awful but I also wouldnt want to do it again. I found it kind of interesting to see how your body heels itself.

If you arent looking to get back to activities that require intense cutting and jumping I'd imagine the cadaver is a good option, but honestly can't say much more than that.

Had ACL reconstruction at HSS in 2012  
lawguy9801 : 11/8/2019 10:33 am : link
I used the patellar tendon, which is the strongest and most preferred replacement but requires more invasive surgery and longer recovery/PT time.

How old are you? Cadaver replacement was only recommended for older patients who would not be performing strenuous athletic activities. Hamstring was the least preferable replacement, from what I recall.

I did PT twice a week for 6 months following surgery. I also did "pre-hab" before the surgery to strengthen the surrounding muscles before surgery, since there is a certain level of muscle atrophy after surgery.

The thing is, though, that your knee never feels quite the same. And now, even 7 years later, with the weather changing it has been somewhat sore lately. But it beats the alternative.

Good luck.
Cadaver may be quicker.  
Giant John : 11/8/2019 10:38 am : link
Not as durable. I’d use my own tendon.
i did patellar tendon  
BH28 : 11/8/2019 10:50 am : link
as mentioned it's an age thing. The preferable method is graft from own body. Regarding patellar tendon vs hamstring, the negative is potential lack of burst from the hamstring where they took the graft. The patellar tendon negative is potential sensitivity from the knee when kneeling and another large incision on the knee that needs to heal.

For rehab, i would recommend purchasing an ossur cold rush cooler. I think insurance only allows it for like two weeks, but i used that off and on for a year.

I would also look into getting a cheap exercise bike for your home to do rehab on your own in addition to the rehab rehab clinic.

The key to successful ACL surgery is being vigilant with the rehab. You should be in a machine that helps you bend your leg literally the same day as surgery. Building up hamstring and quad strength is important for knee stability.

Good luck! Oh and it's weird that they told you your ACL would heal on it own. Its a low blood flow area of the knee so it's extremely rare that even a partial tear would heal on it's own.
RE: Had ACL reconstruction at HSS in 2012  
Everyone Relax : 11/8/2019 11:09 am : link
In comment 14669144 lawguy9801 said:
Quote:
I used the patellar tendon, which is the strongest and most preferred replacement but requires more invasive surgery and longer recovery/PT time.

How old are you? Cadaver replacement was only recommended for older patients who would not be performing strenuous athletic activities. Hamstring was the least preferable replacement, from what I recall.

I did PT twice a week for 6 months following surgery. I also did "pre-hab" before the surgery to strengthen the surrounding muscles before surgery, since there is a certain level of muscle atrophy after surgery.

The thing is, though, that your knee never feels quite the same. And now, even 7 years later, with the weather changing it has been somewhat sore lately. But it beats the alternative.

Good luck.


Sounds like we had very similar experiences. Who was your surgeon?

Agreed that it never feels quite the same, but I got back to playing basketball at near 100% so I can't complain. Little aches and pains come up every now and then but nothing more than a minor annoyance.
ACL  
TyreeHelmet : 11/8/2019 11:10 am : link
I used my Patella tendon as well. Has worked well for me but you do feel pain at the donor site.

- its a rough surgery and will be painful afterwards. Make sure you have the time rest and heal. Its a major procedure.
- I would suggest start PT at a clinic and eventually you will learn what to do on your own. But you need their help in the beginning.
- If you play active sports with a risk of reinjury, I would be very cautious on your return. I believe I waited almost 2 years. I'm talking cutting sports- basketball, football, soccer etc. After a few years you'll forget you even had it done, but be care and patient on the road to recovery.

Last and most importantly, find a great surgeon.Just my 2 cents. Good luck.
Tore my ACL. MCL. Meniscus. Playing basketball  
Earl the goat : 11/8/2019 11:27 am : link
Priorities

Top Surgeon
PT immediately so scar tissue doesn’t impede range of motion
I used my own graft

Was playing basketball 5 months with a brace after surgery
Was at 75% after one year
I was 38 at the time and rehabbed 4x week

Good luck. Find a top surgeon
Mine:  
Torrag : 11/8/2019 11:29 am : link
Own tendon and no problems. Speedy recovery. Felt 100% in 5 months. Done at age 35.

P/T with a pro not on your own. They'll assess you as you come back and keep you from going too far too soon and hurting it.

Crutches until the swelling and pain went down. About two weeks.

Good luck with your procedure and recovery.
RE: RE: Had ACL reconstruction at HSS in 2012  
lawguy9801 : 11/8/2019 11:37 am : link
In comment 14669192 Everyone Relax said:
Quote:
In comment 14669144 lawguy9801 said:


Quote:


I used the patellar tendon, which is the strongest and most preferred replacement but requires more invasive surgery and longer recovery/PT time.

How old are you? Cadaver replacement was only recommended for older patients who would not be performing strenuous athletic activities. Hamstring was the least preferable replacement, from what I recall.

I did PT twice a week for 6 months following surgery. I also did "pre-hab" before the surgery to strengthen the surrounding muscles before surgery, since there is a certain level of muscle atrophy after surgery.

The thing is, though, that your knee never feels quite the same. And now, even 7 years later, with the weather changing it has been somewhat sore lately. But it beats the alternative.

Good luck.



Sounds like we had very similar experiences. Who was your surgeon?

Agreed that it never feels quite the same, but I got back to playing basketball at near 100% so I can't complain. Little aches and pains come up every now and then but nothing more than a minor annoyance.


I used Dr. Answorth Allen, who is one of the Knicks' doctors. You?

I found him because, for the hell of it, I looked up the Giants' team doctor (Dr. Warren), who it turned out didn't take insurance and only took cash payment (I guess when the Giants are your main client you don't need insurance). But Dr. Allen was in the same practice, took insurance and did approximately 150 ACL reconstructions per year. Doctor search over!
RE: RE: RE: Had ACL reconstruction at HSS in 2012  
Everyone Relax : 11/8/2019 11:47 am : link
In comment 14669233 lawguy9801 said:
Quote:
In comment 14669192 Everyone Relax said:


Quote:


In comment 14669144 lawguy9801 said:


Quote:


I used the patellar tendon, which is the strongest and most preferred replacement but requires more invasive surgery and longer recovery/PT time.

How old are you? Cadaver replacement was only recommended for older patients who would not be performing strenuous athletic activities. Hamstring was the least preferable replacement, from what I recall.

I did PT twice a week for 6 months following surgery. I also did "pre-hab" before the surgery to strengthen the surrounding muscles before surgery, since there is a certain level of muscle atrophy after surgery.

The thing is, though, that your knee never feels quite the same. And now, even 7 years later, with the weather changing it has been somewhat sore lately. But it beats the alternative.

Good luck.



Sounds like we had very similar experiences. Who was your surgeon?

Agreed that it never feels quite the same, but I got back to playing basketball at near 100% so I can't complain. Little aches and pains come up every now and then but nothing more than a minor annoyance.



I used Dr. Answorth Allen, who is one of the Knicks' doctors. You?

I found him because, for the hell of it, I looked up the Giants' team doctor (Dr. Warren), who it turned out didn't take insurance and only took cash payment (I guess when the Giants are your main client you don't need insurance). But Dr. Allen was in the same practice, took insurance and did approximately 150 ACL reconstructions per year. Doctor search over!


I pretty much did the same thing. I knew it had to be HSS so I did some research and ended up with Dr. Robert Marx. Maybe not the warmest bedside manner but he churns out ACL surgeries and did an excellent job on mine.
Had my surgery back in 2008  
RomanWH : 11/8/2019 11:57 am : link
Elected to use the cadaver. Didn't like the idea of messing with a perfectly healthy part of my body(patella option) to fix another. Surgery was fine except for the nausea afterwards from the anesthesia. Didn't need too many of the painkillers prescribed to me in the recovery stage.

The PT afterwards, as others have said, was key to my recovery. Not only did they strengthen the muscles around the joint, they also corrected my gait and how I walked to lessen future strain on all of my lower body. I used to wear down the outer edges of all of my sneakers/shoes. Now, not at all. Nice and even with minimal wear. Used to have a noticeable flare out with my toes(duck walking). Now, not at all. Normal with heel/toe, heel/toe full steps.

I did PT for about 3 months. Tore my ACL in Oct, had surgery on Halloween, was back to work by February without restrictions.

Couple of notes:
-Fav part of PT was the electrical things they would stick onto my leg. They delivered a minor electric charge to stimulate the muscles around the knee. Loved the sensation.

-My range of motion was somewhat limited at first. Didn't trust the joint to compress fully. I was at maybe 90% but eventually I recovered full range of motion. Nowadays, I occasionally have some soreness in the knee after hard exercise. Also when the weather changes suddenly, I can feel it. Other than that, I'm grateful that I don't have any further issues with it.
My son completely tore his playing lacrosse,  
Jonesin 4 A Ship : 11/8/2019 1:24 pm : link
They took part of his hamstring to create a new ACL so to speak. He was back in 6-7 months with no restrictions
to add to that,  
Jonesin 4 A Ship : 11/8/2019 1:38 pm : link
he went to a clinic for his PT. I am not sure how much age plays a role in the recovery from a surgery of this type. He was only 16 at the time so I would assume that recovery time is a bit quicker
willing to bet my ACL reconstruction unique  
ColHowPepper : 11/8/2019 6:18 pm : link
but first to answer the OP's Qs: Dr. James Cordasco of HSS advised that for older pts, guessing he means >45 or 50, surgeons opt to take the hamstring (which is not a tendon, but a muscle). If younger, then the patellar tendon. The downside of being older, isn't it everything? ha ha, is that the hamstring tends to stretch and loosen more then the ptendon.

Rehab is crucial and follow instructions!!!!!! Don't try to do more than is programmed. On the night of the surgery, I was on a machine that flexed the knee joint on an electric motor to induce flexibility immediately.

Definitely rehab at a supervised clinic.

Why mine unique: playing American football, 1967, intercepted a pass and planted to reverse field, underestimating the speed at which a 215 lb LB was coming at me, as I planted, he hit square on my knee, I immediately writhed in pain (didn't fumble). Back in those days, x-rays only, and the diagnosis was a partial (mostly) MCL tear, hip to toe cast for four months and rehab for three months. BUT, the x-ray failed to pick up that the ACL (an afterthought in those days) was entirely severed. It wasn';t until after several marathons, followed by a short 5K in 2000--34 years later!!--that the pain was acute, went for an MRI and it revealed that the ACL had been gone, shriveled to nada, for 34 years, then the reconstruction.
Daughter Had one in Each Knee  
Jeffrey : 11/9/2019 8:11 am : link
First one used her hamstring, followed by local rehab. She rehabbed but was overly cautious about re-injury and working with a local PT. Crutches for about 2-3 weeks. Full recovery and playing soccer and basketball again after 8 months, but did not recover her speed for another year.

Second in college. This time occurred in Southern California and we sought three opinions from sports medicine specialists. Surgery performed by one of the sports specialists used by USC. Again used her hamstring, but this time with a much more aggressive rehab she was back playing for her team in 7 months and was faster than she had been prior to the first ACL. Lesson was to take the rehab seriously, don't be lazy and push through the pain in the initial phase as you will be dealing with scar tissue.
Had  
capegman : 11/9/2019 12:18 pm : link
an ACL reconstruction way back in 89. Just snapped when I was cutting playing rb in high school. Had a graft from hamstring. Back then they kept you immobilized for too long. I was in a cast for like 3 to 4 months. By the time they took it off I had like no muscle left. I literally bawled when I saw my leg for the first time.
It took 2 years of rehab in a clinic and on my own before I really played sports again. I wrestled, played JV football in college and varsity track. Lots of pickup basketball and jogging with no major issues.
The problem was it was immobile for so long I never got full range of motion bending it back and the muscle atrophy was horrible and explosiveness was 2 to 3 years of rehab in getting back.
Don't let the atrophy get too bad is my biggest advice .
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