Partially torn acl

[Dirty Holt]

No they are not What info did you present re: PT vs Quad braided hammy? They don't do PT grafts here - and as I understand it, these are riskier for grapplers anyway (due to the fact that it restricts kneeling / increases risk of patellar fracture at later stage).

I had quad braided hammy: the tunnel placements are good (a whole other topic...!) but I know if they went in and did a second graft, they'd either have to drill a second tunnel OR widen the existing tunnels (if I went for something like LARS). Complications all around

If you've had three, can you tell me more about what they used the second/third time, complications etc?

Knees suck, man. That's all I've got to say on that

There is a reason why professional/Olympic athletes get PT grafts over hamstring. The fears about harvesting a PT and doing damage are myths; the research 100% does not show any link between a pt harvest causing injury. IN addition, if this were the case, hamstring would be out of the question completely if harvesting caused additional injuries.

I had two allografts of a quad braided achillies, then my PT graft which was a thousand percent better in terms of recovery time and strength. Both knees are fine, the one that got the PT graft is stronger. There were zero complications minus some scar tissue got popped off in a competition about 7 months after first allograft. That hurt and was scary, but my knee was fine within a few minutes.

 

[machomang]

Did you go through any mental walls overcoming an injury like that? I'm a bit apprehensive knowing that my acl is not 100% and never will be.

 

[selfcritical]

There is a reason why professional/Olympic athletes get PT grafts over hamstring. The fears about harvesting a PT and doing damage are myths; the research 100% does not show any link between a pt harvest causing injury. IN addition, if this were the case, hamstring would be out of the question completely if harvesting caused additional injuries.

I had two allografts of a quad braided achillies, then my PT graft which was a thousand percent better in terms of recovery time and strength. Both knees are fine, the one that got the PT graft is stronger. There were zero complications minus some scar tissue got popped off in a competition about 7 months after first allograft. That hurt and was scary, but my knee was fine within a few minutes.

I'm wondering where they get that impression. My surgeon mainly does pro and Div 1 football players, normally does PT graft, but insisted on the hamstring graft when he found out I grappled.

 

[Kbits]

Did you go through any mental walls overcoming an injury like that? I'm a bit apprehensive knowing that my acl is not 100% and never will be.

Like you wouldn't believe.

 

[Kbits]

Hey Holt

How fast was the PT graft compared to the Achilles? Was it on the same knee and if so, did they have to re-do one of the tunnels?

They just don't do PT here - at all. I spoke to 3 surgeons; gold standard is hammy, then Achilles for second one. They *were* keen on LARS (ligament augmentation: basically gortex, like they use to use in shoulders) some time ago but it kind of fell out of favour (though seems to be coming back).

Mostly I'm interested in any stuff you have on testing for stretched ACLr. I can read MRI somewhat, and pointed out to the Ortho that to my eye, the PCL seemed to be buckled (an indication of ACL stretching) which got brushed aside.

http://sumerdoc.blogspot.com/2012/02/signs-of-acl-tear-on-mri-residents.html

 

[selfcritical]

https://mikereinold.com/acl-hamstring-grafts-fail-patellar-tendon-grafts/

Looks like they're pretty similar over long term, but that the PT graft is MASSIVELY better in the first year.

Which makes sense if the HS graft makes your hamstring temporarily weaker, since it resists translation forces

 

[tonyNGUYEN]

Depending on the country you live in there is going to be a bias to either a BTB (PT) graft or Hamstring graft. In Canada, HS grafts are more commonly done although there are surgeons who do BTB grafts. I believe Austria is HS dominant and the UK is PT dominant..

Allografts have higher re-rupture rates than any autograft (including HS) in young active populations.

BTB (PT) graft:
- bone-to-bone healing
- slightly lower rates of re-rupture (compared to HS)
- no hamstring weakness

- anterior knee pain (+ pain when kneeling)
- possible elevated risk of earlier PF arthritis (although all ACL tears are associated with earlier arthritis development at the knee)

HS graft:
- no anterior knee pain

- hamstring weakness (clinically usually not noticeable in the long term)

Fun fact, there are some MRI studies that show some form of regeneration of the HS tendon after surgery... (obviously not full regeneration)

I just had my ACL reconstructed 1.5 weeks ago with a HS graft.

Most importantly, find a good surgeon who preferably does a high volume of ACL reconstructions and has experience working with athletes.

 

[drabon74]

You should look into steam cells mixed with a little prp

This, do yourself a favor and research this asap.

 

[Dirty Holt]

For those stating that anything but PT graft is gold standard, I would highly suggest doing some in depth research and considering going somewhere else. PT graft preferred 400% more than hamstring by NFL players. Allografts are 770% more likely to fail than a PT graft. PT graft proven more effective with less failure and complications across all ages, genders, and athletic status. Here are the studies in one quick powerpoint if you are interested.

Again, there is a reason why NFL players, pro, and Olympic athletes get PT grafts. Its because they go to cutting edge surgeons who keep up with the facts and change their approach with research VS. Charlie the Ortho who graduated in 1982 and only sees average Joes and the elderly in the town. The guys doing hamstring grafts on athletes do it because they are the best at that graft over becoming an expert in a new way.

http://tria.com/wp-content/uploads/2014/07/ACL-Reconstruction-in-the-Competitive-Athlete-Matava.pdf

I had 3 ACL's, so one got an allograft then a auto. Yes they redrilled but my bone was completely grown back; thats a non issue. Recovery time was exactly the same. At 6 months I was much further along when I stepped back into competition on an autograft. As far as MRI, my ortho told me every time that getting one was a waste of time. He knew exactly what was wrong from the tests, and a compromised ACL means reconstruction if you want to be elite. I got free instant access to MRI, and he was 100% right each time. Seriously, this guy is a fucking wizard with knees and get sought out by the best of the best athletes. If he tells me what all of the pros and Oympians are doing, Im gonna trust him way more than some 65 year old guy working on Uncle Steve and Grandma.

 

[tonyNGUYEN]

For those stating that anything but PT graft is gold standard, I would highly suggest doing some in depth research and considering going somewhere else. PT graft preferred 400% more than hamstring by NFL players. Allografts are 770% more likely to fail than a PT graft. PT graft proven more effective with less failure and complications across all ages, genders, and athletic status. Here are the studies in one quick powerpoint if you are interested.

Again, there is a reason why NFL players, pro, and Olympic athletes get PT grafts. Its because they go to cutting edge surgeons who keep up with the facts and change their approach with research VS. Charlie the Ortho who graduated in 1982 and only sees average Joes and the elderly in the town. The guys doing hamstring grafts on athletes do it because they are the best at that graft over becoming an expert in a new way.

http://tria.com/wp-content/uploads/2014/07/ACL-Reconstruction-in-the-Competitive-Athlete-Matava.pdf

I had 3 ACL's, so one got an allograft then a auto. Yes they redrilled but my bone was completely grown back; thats a non issue. Recovery time was exactly the same. At 6 months I was much further along when I stepped back into competition on an autograft. As far as MRI, my ortho told me every time that getting one was a waste of time. He knew exactly what was wrong from the tests, and a compromised ACL means reconstruction if you want to be elite. I got free instant access to MRI, and he was 100% right each time. Seriously, this guy is a fucking wizard with knees and get sought out by the best of the best athletes. If he tells me what all of the pros and Oympians are doing, Im gonna trust him way more than some 65 year old guy working on Uncle Steve and Grandma.

Hey Holt,

Do you have a specific physio protocol you swear by after 3 ACL surgeries?

 

[Dirty Holt]

Hey Holt,

Do you have a specific physio protocol you swear by after 3 ACL surgeries?

Here is the deal that I came to an understanding with when dealing with multiple Olympic PT's: A one size fits all comprehensive program for ACL rehab is less efficient than continually testing the athlete and coming up with the program as they progress. For me, I always had tons of strength, decent balance, and great proprioception, and lacked with cutting, certain balance positions, and flexibility. I noticed that I was on the same program as a female gymnast and another female wrestler who all had ACL's at the same time. I found that to be very short sighted that I would be working balance the same as an Olympic gymnast, and a female wrestler would be working strength just like me. It takes and incredible amount of perception and knowledge to create your own PT curriculum, but if you can do it, it blows the canned timelines out of the water.

I will say, there are certain things I did as far as modalities that I swear by that makes people think I am crazy but it works way better than what everyone has always done. Sometimes you have to think outside of the box if you want the absolute fastest and strongest recovery.

 

[tonyNGUYEN]

Here is the deal that I came to an understanding with when dealing with multiple Olympic PT's: A one size fits all comprehensive program for ACL rehab is less efficient than continually testing the athlete and coming up with the program as they progress. For me, I always had tons of strength, decent balance, and great proprioception, and lacked with cutting, certain balance positions, and flexibility. I noticed that I was on the same program as a female gymnast and another female wrestler who all had ACL's at the same time. I found that to be very short sighted that I would be working balance the same as an Olympic gymnast, and a female wrestler would be working strength just like me. It takes and incredible amount of perception and knowledge to create your own PT curriculum, but if you can do it, it blows the canned timelines out of the water.

I will say, there are certain things I did as far as modalities that I swear by that makes people think I am crazy but it works way better than what everyone has always done. Sometimes you have to think outside of the box if you want the absolute fastest and strongest recovery.

Good answer.

So would you say your rehab was different after each ACL surgery? (Dependent on your strength/deficits during the time)

For return-to-training / return-to-competition, how long did it usually take you for both? From what I have been reading any return-to-sport prior to 9-months is associated with much higher risks of re-injury: http://bjsm.bmj.com/content/early/2017/05/17/bjsports-2016-097124)

What criteria did you or your PT have for yourself before you felt comfortable with returning to training and competing?

 

[Dirty Holt]

Good answer.

So would you say your rehab was different after each ACL surgery? (Dependent on your strength/deficits during the time)

For return-to-training / return-to-competition, how long did it usually take you for both? From what I have been reading any return-to-sport prior to 9-months is associated with much higher risks of re-injury: http://bjsm.bmj.com/content/early/2017/05/17/bjsports-2016-097124)

What criteria did you or your PT have for yourself before you felt comfortable with returning to training and competing?

The rehab changed as well as the modalities. The first one I followed the canned protocol to a T. Second one we worked together and added a few things, changed timelines, and went lighter on stuff. Third one I did myself completely and it was the most successful.

Each time I was back in 6 months. The injury recocurrance was not from a failed graft. They were all freak injuries. 1st I had a new pair of shoes that had mondo grip, I spun, the shoes dug in and my body kept going. 2nd one was the other leg, I slipped on some sweat near the edge of the mat, compensated, planted off the mat and slid off the elevated platform, and landed a few feet down in a compromised position. 3rd one was two guys who weighed about 285lbs each crashed into me.

For return to play, the minimum was 6 months then I had to do a battery of tests with strength, balance, flexibilty, ROM, and cutting. The tests were useless. My entire job for 6 months was rehab 3x a day or more, and I could pass those tests at 5 months out easily. Rest and time was basically the hardest because I cant make those go faster.