Torn ACL

**zlarin** · Posted On: 1/07/2009 4:28pm

In a game of lifeguard-football, I tried to intercept a pass and landed funny. Cue knee pain. I had a friend of the family, who also happens to be a physical therapist look at it, and he said it was most likely a slight meniscus tear. I would have gone to a specialist sooner, but the PT advised to wait and see how my knee feels before we take any medical action. After a few days, there was no more knee pain and I've been walking around on it for about 5 months now. I've been having issues with my throws in judo and haven't been able to go to karate at all due to my knee having a "slipping" sensation, though I've been relatively able to roll in jiu jitsu without much trouble. I've been busy with school, so I haven't seen a doctor during the last semester, so I scheduled an appointment over winter break. Just got back from an orthopedic specialist today and he told me that I have a completely torn ACL. Damn. My surgery is probably going to happen the week after my semester in college is over followed by an adddiction to percocet.

I have a couple of questions for those who may be knowledgeable in this area. I have been given three options for my source of my new ligament: a cadaver, my patellar tendon, or my hamstring. I'm a little leery about the cadaver option, as the doc talked about the risk of disease transmission and the extra time it will take for my body to adapt to foreign tissue, and I know little to nothing about what the benefits would be from the other two sources, as the doc was pretty vague about them (said, "there are risks and benefits for each source").

Also, I've been advised to not run (although so far I've had no trouble for the past 5 months) and have, of course, been told to stay out of the dojo. The doc advised me to weight lift and use an elliptical to strengthen my legs as much as possible b/c I'll be losing muscle over the course of my recovery. I'm planning on swimming alot, lifting as much as necessary, and maybe using a stationary bike. Any other suggestions?

If there's anything you guys have experiened with an ACL tear that you'd want to let me know, or if there's any advice on the recovery process, I'd love to hear it.

Can't wait till I can do this again. -->:karated:

**meataxe** · Posted On: 1/07/2009 5:55pm

I tore ACL/PCL/MCL all at once. The repairs were done using tissue from patellar tendon and LCL. It worked, more or less. I wouldn't expect to ever be 100%.

The downside, I suppose, is scar tissue in patellar tendon area and possibly a bit more physiotherapy required. I'm not aware of any other issues.

**Tom Kagan** · Posted On: 1/07/2009 7:56pm

If you swim, avoid the frog kick and using an egg beater motion while treading water.

ACL threads:

ACL surgery - How did you get back in the game? - No BS Martial Arts
Arthroscopy tomorrow - No BS Martial Arts
MMA after ACL tear - No BS Martial Arts
Training with a torn meniscus. - No BS Martial Arts
Who's torn their ACL? How do you know? Advice? - No BS Martial Arts

**bob** · Posted On: 1/07/2009 8:05pm

Originally Posted by zlarin

I have a couple of questions for those who may be knowledgeable in this area. I have been given three options for my source of my new ligament: a cadaver, my patellar tendon, or my hamstring. I'm a little leery about the cadaver option, as the doc talked about the risk of disease transmission and the extra time it will take for my body to adapt to foreign tissue, and I know little to nothing about what the benefits would be from the other two sources, as the doc was pretty vague about them (said, "there are risks and benefits for each source").

Generally speaking the cadaver graft is less invasive and has less postoperative pain, but ends up not as strong as the other two. It's usually reccomended for people who are not going to put huge amount of stress through the graft. There's also increased risk of disease transmission.

The patella and hamstring are both equally strong and both equally prone to long term pain as a side effect (in the case of the patella about 90% get some kind of pain in the long term around the kneecap, in the case of the hamstring, 90% tend to get hamstring problems). The return to sport time for these two is about 9 months on average. Neither is necessarily better but each surgeon will have a preferred procedure that they're especially good at (or they should do).

If you want to return to martial arts I'd go with the patella or hamstring graft.

**Tom Kagan** · Posted On: 1/07/2009 8:14pm

Originally Posted by bornsceptic

Generally speaking the cadaver graft is less invasive and has less postoperative pain, but ends up not as strong as the other two. It's usually reccomended for people who are not going to put huge amount of stress through the graft. There's also increased risk of disease transmission.

The patella and hamstring are both equally strong and both equally prone to long term pain as a side effect (in the case of the patella about 90% get some kind of pain in the long term around the kneecap, in the case of the hamstring, 90% tend to get hamstring problems). The return to sport time for these two is about 9 months on average. Neither is necessarily better but each surgeon will have a preferred procedure that they're especially good at (or they should do).

If you want to return to martial arts I'd go with the patella or hamstring graft.

Cadaver grafts have a greater post-op chance of not taking. They are not "weaker" if you don't have that complication. Contrary to what you suggest, a lot of athletes get them because they allow a greatly shortened time to return to competition.

Renzo Gracie opted for a cadaver graft for his ACL reconstruction in 2005.

**bob** · Posted On: 1/07/2009 8:21pm

Originally Posted by Tom Kagan

Cadaver grafts have a greater post-op chance of not taking. They are not "weaker" if you don't have that complication. Contrary to what you suggest, a lot of athletes get them because they allow a greatly shortened time to return to competition.

Renzo Gracie opted for a cadaver graft for his ACL reconstruction in 2005.

I can't be bothered to track down the original study but...

Allograft (Donor Tissue)
Allograft is most commonly used in lower demand patients, or patients who are undergoing revision ACL surgery (when an ACL reconstruction fails). Biomechanical studies show that allograft (donor tissue from a cadaver) is not as strong as a patient's own tissue (autograft). For many patients, however, the strength of the reconstructed ACL using an allograft is sufficient for their demands. Therefore this may be an excellent option for patients not planning to participate in high-demand sports (e.g. soccer, basketball, etc.).

http://orthopedics.about.com/cs/aclr...clgrafts_2.htm

This is for a successful graft. As you say, there is the additional risk of them not taking.

I never suggested they didn't allow a shortened return to competition. Quite the opposite, I said there is less trauma and post operative pain involved. What I'm saying is that the ultimate outcome is a graft which is not as strong as the other two methods.

Without second guessing the surgeon or their professional athlete patients I would suggest that those that opt for it are doing it to maximise their incomes during the brief window of their professional careers and accepting a slightly higher risk of failure.

**Tom Kagan** · Posted On: 1/07/2009 8:33pm

Originally Posted by bornsceptic

I can't be bothered to track down the original study but...

http://orthopedics.about.com/cs/aclr...clgrafts_2.htm

This is for a successful graft. As you say, there is the additional risk of them not taking.

I never suggested they didn't allow a shortened return to competition. Quite the opposite, I said there is less trauma and post operative pain involved. What I'm saying is that the ultimate outcome is a graft which is not as strong as the other two methods.

Without second guessing the surgeon or their professional athlete patients I would suggest that those that opt for it are doing it to maximise their incomes during the brief window of their professional careers and accepting a slightly higher risk of failure.

Fair enough.

I suppose the skill and experience of the surgeons greatly affects the differences in the study. My thoughts may be skewed by the #1 hospital for Orthopedic surgery being here in NYC.

**bob** · Posted On: 1/07/2009 8:40pm

Originally Posted by Tom Kagan

Fair enough.

I suppose the skill and experience of the surgeons greatly affects the differences in the study. My thoughts may be skewed by the #1 hospital for Orthopedic surgery being here in NYC.

The skill of the surgeon should always be your primary consideration obviously. I would suggest that there are physiological reasons why grafting with someone else's dead tissue will never end up as strong as grafting with your own. Whether you believe that trade off is worth the benefits it gives ultimately is up to you.

**zlarin** · Posted On: 1/07/2009 9:53pm

hey thanks for all the info guys, it looks like the most likely route will be the patella graft for me after talking with a few people, and it seemed that my doc was trying to push me more in that direction. seiza isn't going to be too fun anymore.