Hi, was hoping to get some feedback from folks who have had ACL surgery in terms of what kind of graft they used. Unfortunately, I recently suffered a complete tear of my ACL along with a torn meniscus with surgery scheduled for the 13th of Feb. I’m in my early 50’s and under consideration of my desire to get back to my pre-injury level of activities (I race cyclcross and mtb, along with being a life-long avid skier) the doctors initial recommendation was an allograft - due to my age and his view that there is not a meaningful difference in the structural integrity of the knee between the two options (as well as the more invasive nature of harvesting a tendon from your own body). I’m trying to sift through the plethora of information on-line, but still haven’t come to firm conclusion on which way to go. Any feedback would be greatly appreciated.
I was 43ish when I tore mine… only with 15-20% meniscus left
Went Allograph route…
5+ years later… still not to pre-level and frankly I dont think it’s gonna happen. Cyclocross might be hard… MTB is probably ok. I have not touched my snowboard since.
I think what’s holding me back is the lack of meniscus… if you are lucky enough to retain a good amount of yours… your results might be better then mine.
Allograft and meniscus repair about 12 years ago (I’m 43 now so early 30’s when I had surgery). As I recall the two main reasons were 1) only one surgery site which meant less chance of infection or complication, easier healing, etc., and 2) my doc told me the allograft had the potential to be stronger than my own tendon. Honestly I don’t remember why that is the case but that’s what he said at the time.
Both are pretty common procedures, I wouldn’t overthink it - if you’re comfortable with your doc then just go with what s/he recommends. I was fully healed and back to full activity in around 9 months and have had no issues since, aside from a little minor discomfort around the scar occasionally.
my doc told me the allograft had the potential to be stronger than my own tendon. Honestly I don’t remember why that is the case but that’s what he said at the time.
.
probably because the donors are under 30… not so much an issue for you at the time since you where in your early 30’s
Thanks - makes sense in terms of comfort level of doctor. I’ve been lucky in terms of this being my first major injury that requires surgery, so definitely feeling a bit apprehensive about it.
I think everyone will end up with a difference experience, at least that’s been the case with the people I’ve spoken to who’s torn an ACL.
I’ve torn both and didn’t have surgery the first time (right knee in 2009) but did go with an autograft when I tore my left ACL in 2014 and the one I didn’t have surgery on is miles better, to the point where I don’t notice it. I did all the PT and exercises on both occasions and I was told by my PT at the time that strengthening the muscles around the knee would be fine unless there were certain sports I wanted to get back to. I’ve even gone skiing with no issues but had to give up playing football/soccer which made me take up triathlon.
I’m no expert by any means and I’m sure both options are fine but wanted to throw my experience in there since I’ve torn both and went down two different roads.
I had an autograft (pattelar bone ligament bone), my surgeon preferred hamstring autografts, but I had a few other ligaments replaced at the time.
If you can keep with the pt to rebuild the hamstring that is the way to go. I was non weight bearing for 6 weeks post op so there was no way for me to get right into the pt needed.
If you do the pattelar autograft that part of your knee will be extremely sensitive to contact. I have hit my knee on my car dash more than I care to admit, and it will nearly bring tears to my eyes.
Make sure you treat the rehab like a second job, your VMO will begin atrophy in less than 24 hours.
I would tend to agree with your surgeon that at 50 years old, the recovery from an autograph could be worse than the bone drilling etc.
I had my PCL done 6 years ago and then it tore again last year mainly becauSe the LCL was torn too and they might have missed it.
All have been allograft. Neither of the surgeons I’ve had like using autografts in athletes because you’re making something stronger by making something else weaker and you’re basically recovering from two surgeries.
Thanks - very helpful. My inclination has been to go with an allograft, but I think you can make a compelling case for both. The extent of the damage to the meniscus will certainly play a part in my final decision.
Thanks - very helpful. My inclination has been to go with an allograft, but I think you can make a compelling case for both. The extent of the damage to the meniscus will certainly play a part in my final decision.
they won’t know until they get their camera in there as to the meniscus… Mine was worse then the scan showed. My doc was doing transplants for ppl sub 50 at the time for ppl that had damage like mine. Since they did not have the “new” part ready…and I didn’t want to go back under the knife unless I had too … I really didn’t have a choice other then to lop a big part of my meniscus off. My gate was severely impact pre-surgury and I could not walk without crutches.
I say just go allograft , the rehab should be faster.
When l was 38 years old, I ruptured my left ACL/fractured tibia/grade 2 tear in the collateral ligament, in a skiing accident in 2002. I was advised against the donor graft and to go for a hamstring tendon graft with keyhole surgery.
During the op, they found that the meniscus was pretty bashed up, but not torn - surgeon trimmed the edges, did the hamstring graft, small screw in front of left leg, l ended up with 5 tiny scars.The leg did swell even though l had it in an cooling tray all night. Anyway, it got better, but you have to give the graft minimum 6 -8 weeks to get nicely embedded ! You also have to do all the exercises to fire up the muscles again - without fail ! It took about 6 months before l was show jumping again but in reality its a 12 month complete recovery. The following year, l had the grade 2 tear injected to close the hole that was there, that is a series of injections done over a few weeks.
I did ski again but always had a brace on the left knee. From 2011 l did marathons and some 70.3’s.
When l completed my first IM in 2016, l sent my surgeon a picture and told him that his handiwork had stood the test of time alright !
Thanks - I’m probably going to agonize over this in the lead up to surgery, but as one of the earlier posts mentioned, I shouldn’t over think it too much. As long as the doctor does his job and provided I focus on the rehab, I’m guessing it will all work out (hopefully).
Tore my ACL, MCL meniscus and some other damage back in 2002. I was a little over 30 at the time. Had the hamstring autograph for the ACL. Recovery sucked, but I rehabbed hard and religiously and made what I consider about an 85% recovery. No problems since with that knee and I’ve been able to run up to IM distance Tri and ultramarathons in the years since, but that leg has never really quite felt the same. And while I haven’t been mileage limited at all, I was never able to get back to the running speed I had pre-injury…
Your surgeon should really guide you, I was lucky and did not have any damage to my meniscus, but had my lcl, acl and popliteus replaced. I had to wait 5 weeks from accident to surgery to allow the fibular head to heal before they drilled it for the lcl as it was shattered. All this to say my surgeon remarked “you have an honorary degree in knee anatomy and reconstruction.â€
He remarked after age 35 they won’t do an acl unless the patient is very active competitively. Patients tend to not stick to rehab protocol as much as it needs to be. The average American male does not have sufficient VMO muscle mass to make it to the point of regaining muscle.
At your age, you really should be minimizing collateral damage. You are also facing increased odds of a knee replacement and having an autograft would set you back at least a year on recovering muscle mass in your hamstring.
I don’t know the date of your injury, but an acl should be replaced in the “acute†phase of the injury aka, ASAP. If you have to put it off by weeks, you should put it off long enough to do plenty of pre op pt to regain rom and build strength as the muscles around the knee atrophy within 24 hours of more than 10ml of fluid gather from inflammation.
(1) the most important thing by far is the surgeon, not allograft vs autograft. You should make sure to get a surgeon that has tons of experience, does several per week, and ideally is recognized as great - maybe the guy who does your local pro sports team. That is #1 by far. Speculating here, but I think exact placement of the graft matters for leg stability, and good surgeons also put less stress on the knee during surgery. On the graft, the RCTs show no benefit to autograft except in quite young people (can’t remember the age as it has been almost two years since I researched it, but it was something like <20).
(2) My experience: had my ACL done at 49 – complete tear from skiing accident, with torn meniscus. I realize this is a bit atypical, but I was on the bike trainer in 5 days, rode outside starting at 7 days, raced a TT after 3.5 weeks (albeit badly), and was pretty much normal after that. (At exactly 4 weeks I pre-rode the queen stage of the ToC and my climb times were close to normal.) At this point (1.5 yrs) I honestly can’t tell the difference between my two legs. I had a top notch surgeon, started with high base fitness, and was diligent about the rehab. If that sounds like you it really isn’t that big a deal.
(3) The reason the surgeon said the graft could be stronger than your original ACL is that it typically starts out that way. They use an achilles or patellar tendon that is thicker than your original ACL. It is screwed into the bones at each end. Once the bones heal, the graft is very strong, at least at first. However, because it is dead tissue it then starts to die/deteriorate. It hits a low point at around 6 months, when it can be quite weak, say 50% of your original ACL. If all goes well, however, your body eventually vascularizes the dead tissue and it starts to get replaced by new tissue. After about a year, again if all goes well, it goes back to being strong again, though not likely as strong as your original ACL. This is why you can’t do field sports or skiing for so long after an ACL repair, even if you feel pretty normal. You have to wait for this whole process before it’s safe.