The ACL Repair Blog Firsthand accounts of ACL surgery and recovery

Hey All-

I got a simple forum going. It’s still a bit rough around the edges, but I’m hoping this will be an easier format for keeping in touch with eachother and talking about our knees. I apologize that you need to register in order to post on the forum, but I just couldn’t figure out a good way to do it without registration.

So please take a minute to sign up and come join me in conversation at the forum.

I’ll try to keep updating the blog with the most interesting stuff from the forum.

Please let me know if you have any suggestions! I’m happy to do whatever it takes to make this site work for you.

- Henry

Hello ACL Bloggers!

My recovery has been going so well that it really hasn’t been at the forefront of my mind. I’m back to commuting on my bike, doing some light hiking and generally living it up. Sadly, this means i’ve been totally ignoring the awesome community here at ACL-Repair.com . I’m totally overwhelmed (and overjoyed!) by the awesome community that has sprung up around this blog and want to ask you the readers what I can do to make it most useful for you?

It seems like most of the comments I’m seeing are discussions about various people’s surgeries and recoveries. Does it seem like this discussion would work well in a forum type layout? Where everyone could start topics and people could respond? Or would it be better if we just had more people posting stories on the blog?

Let me know in the comments because i really do want to keep this awesome community alive.

Thanks so much for all the participation!

- Henry

I realized today that all the emails from the “tell us your story” form were getting caught in my spam filter! And here I thought nobody cared. I’ll be getting back to all of you in due time, sorry it’s taken me so long! Look for some new posts from some of the awesome people that have mailed us to tell us about their knees!

Today I went in for my three month post operative checkup. The doctor asked me a few questions about how my knee was feeling and did his standard exam of the joint. He declared it to be nice and tight and told me I could ride my bike as much as I want, just not to fall ;).

He recommended that i keep going to physical therapy once every other week for a while. I need to check with my insurance to make sure they’ll keep paying, but I’ve been so happy with my PT that I would like to keep going as long as i can.

He reiterated the fact that Allograft tends to take longer to heal.  He indicated that by 6 months out it should be as strong as an autograft would be.  The doctor made a point of telling me that he could start me on a running program at six months, I was not excited about that at all.

Being cleared for bike off is fantastic news.  That means I can start getting my miles in and hopefully be in good shape for some longer rides this summer.   The hardest part will probably be taking it easy and keeping myself out of potentially dangerous situations.

Last night after dinner I was feeling restless and decided to brave the dark and cold for a ride. My route took me south around Lake Union to Fremont where I climbed up the gentle hill of Stone Way to Greenlake. I did have a little soreness during the climb, but nothing that alarmed me. From Greenlake I followed the path of the ill fated Ravenna Creek down to the Burk Gilman trail.

Again it felt fantastic to be on the bike.  I’m incredibly wary of traffic and rough terrain and still keeping it nice and easy.  My average speed was down around 12mph which is probably about 2/3rds of my pre injury speed for a ride like that.

If nothing else last night’s ride made me even more excited about the coming spring and the bicycle borne adventures it’s sure to bring.

I was sitting in a meeting yesterday when i got an email from my dad saying my mom had taken a fall on the ski slopes and torn her ACL and possibly her MCL.  We’ve got all the luck in this family!  She had actually injured the ACL in her other leg several years ago.  My dad also tore his ACL and had the surgery about 15  years ago.   That puts us at 5 torn ACLs between the three of us!

With any luck I’ll get her to come write about her experiences here.

Saturday was a momentus day for me in that I took my trucker out on the road.  My girlfriend and I rode about 10 miles round trip from our place in Eastlake (Seattle) to Ballard for sandwiches.  It felt fantastic.  I had no knee pain and my legs felt quite strong.   Of course, the route was completely flat and largely on bike paths which helps.  I’ll definately need to get some miles in before i have the confidence to hit the roads with my former gusto.

Yay for bikes!

Hey all, I just upgraded the wordpress install on the old ACL blog. If you see anything funny going on let me know. Thanks!

This is mostly from a review on ACL reconstruction: Spindler, KP and Wright, RW. 2008. Anterior Cruciate Ligament Tear. New England J of Medicine.

1. Weight bearing right after surgery does not cause harm.

2. Using passive motion machines is not any better than not using them.

3. Use of a brace is no better than not using a brace.

4. Exercises bending the knee (like squats) are better than exercises that extend the knee.

5. Motivated people can do just as well at home as at Physical therapy (But are any of us that motivated that we can do as good as a professional?)

This has come up a lot in this blog in the posts and comments.

What is better autograft (hamstring or patella) or allograft (from a cadaver)?

As a biology graduate student I have access to scientific publications and some experience in assessing the published information. There are no official published guidelines for doctors, just scientific articles. Here is what I have found from articles comparing allograft to autograft:

1. There is a lack of randomized trials to compare auto- vs allograft. Randomized studies are very important in science. Think about your doctor. He or she has an opinion on which is better. So the graft you get may be biased by that opinion or, if you decide opposite that doctor’s preference, the surgery itself may be biased. Randomized trials would be if you went to the doctor and picked a surgery (allo- or auto-) out of a hat. These have been done comparing patella tendon versus hamstring but not allo- versus auto-.

2. Failure rate for allograft is significantly higher (9 of 158) than autograft (2 of 167) in observational studies. The review (first citation) recommends autograft, especially for young athletes.

3. Greater chance of deep infection with autograft (2 out of 170) versus allograft (4 out of 628). Significant difference, but all in all, risk was low, maybe too low in this study to tell if there is really a difference.

4. Allografts take longer to revascularize

Additional interesting information I found:

0. There is really no difference in results from patella or hamstring, but patella causes a little more pain. I know this wasn’t auto- vs allo- but still relevant.

1. ACL reconstruction in patients over 50 can be as successful as in younger patients

2. 175,000 ACL reconstructions were performed in 2000

3. Osteoarthritis occurs in 50 % of patients that tear their ACL 10 to 20 years after injury.

4. 60-70% of ACL tears also damage meniscus cartilage.

5. Non-operated ACL tears are more likely to cause further cartilage damage than ACL reconstruction.

6. 15% of patients need additional cartilage or scar tissue surgery after ACL reconstruction (I did for my first knee).

7. Means of graft fixation (how they attach the graft) does not affect outcome

8. Risk of tearing a graft is about 3% after 2 years, the same as your ACL in your other knee (which is what happened to me after 5 years).

I will post later about differences in rehabilitation.

Citations:

Spindler, KP and Wright, RW. 2008. Anterior Cruciate Ligament Tear. New England J of Medicine Katz LM,

Battaglia TC, Patino P, et al. 2008. A Retrospective Comparison of the Incidence of Bacterial Infection Following Anterior Cruciate Ligament Reconstruction With Autograft Versus Allograft. Arthroscopy.

Dahm DL, Wulf CA, Dajani KA, et al. 2008. Reconstruction of the anterior cruciate ligament in patients over 50 years. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME