Reconstructing knees?

Riding the Mt. Bike was more of a personal choice and not really out of the question as stated earlier.
Those skinney tires and clipless pedals just really spooked me. What really is out of the question is taking a fall off of a bike during the beginning stages of recovery. It wouldn't take much of a twist to tear any "Graft."

Keep it up folks, I am listening & learning.
One more topic that's been lightly skimmed- cadavor Vs hamstring Vs platellar tendon. If it matters I am 36 and pretty strong/fit for starters -thick legs/muscular. Speed runner/fast twitch type.

My Doc uses the "Cadaver tendon" on all ACL reconstructions. He said the recovery is quicker with less trama. Taking a graft from the hamstring or petella can lead to problems of that area later on. (Doc's comment)
My Doc also said he uses the "Cadaver tendon" on all of the Elite Athelites.

The comment that 'Paul Hunnicutt' made about the possible "Cadaver Tendon" snapping scares the hell out of me and I don' know how true that is. I've been told that failure rates with both "Autograf" or "Allograf" is due to the graft not being done right so getting an experienced Doc is very important!

Tony, I also had ACL repair about 12 or 14 years ago by David Grauer in Boulder. I really liked him. I had the hamstring as I had previous cartilage trims to that knee and he felt using the patella tendon would not be as good as the hamstring. I tore the ACL in Feb (moving my pack at the base of Piles of Trials) and did not have it repaired until Nov (20th I think). I was riding a bike at Christmas out in LA.

Good luck.

As far as what to replace your torn ACL with - I have had them all - first one in 1984 - they just sowed it back together - well duh - that made sense - right? I tore that one out second race of the next season. Then had the Hamstring redo - and it is still good to go - no brace and plenty strong. Then the right knee began to tear - In 1989 they put in a piece of Gore-Tex - thinking the old ACL would grow back through the pores of the gore tex and regenerate - tore that one out mid ski season - then had the patella tendon redo - tore next season - finally had the hammie redo and it is super super strong.

I have no problems whatsoever - just make sure to keep your hamstrings really really strong. If you have huge quads like most skiers and bikers - the quad will retract when you go into the "backseat" while skiing, and you can tear the ACL with no fall at all. Remember Debbie Armstrong - the female skier from back in 1984, she hit the backseat in her last race and it tore the ACL without her even going down. 80% ratio to Quad strength is what you want to shoot for. ( If you can leg curl 100 lbs on each quad - make sure you can hamstring curl 80 lbs)

The knee is the weakest joint with the most stress on the entire body - keep em' healthy and turn your DIN settings down to a reasonable # - not 15!

Brian

I'm not a doctor at all so take my comments with that in mind. My doctor recommended the Patella as the "Gold Standard." However, he actually said he had been doing a lot of hamstrings lately (this was 2004) and recommended that as my first option. Cadaver was a distant third in his opinion and he only does it on older patients. My doctor did a lot of work with NFL players.

My research on the internet revealed several stories of cadaver ligametns breaking down after a while due to the body rejecting the tissue...again I'm not a doctor and it wasn't like I was reading the New England Journal of Medicine. Go with what you and your doctor determine is best.

I went with Patella, because I had had friends who had success with it, it is "tried and true,"
and I've always had trouble with tight hamstrings and didn't want to mess with them. I had no desire to do the cadaver - simply because the idea of someone else ligament in me seemed to creepy and also it was my doctors #3 choice.

In the end each one has drawbacks:

Patella - One of the oldest methods and a very successful track record. However, sensitive patella while kneeling and possible patella tendonitis later on (I've had no problems with tendonitis). I was told 90% of the patella grows back...more like scar tissue, but it does the job. Also I've heard this is the "tightest" of the grafts. Hamstring is a bit "looser" Don't know how true this is. Occasionally I bump mine climbing, but it isn't really an issue. If I had a climb with serious knee bar action where it rock was directly impacting my patella I'd need a kneepad. I don't climb at Rifle that much though and I haven't really come across this problem yet.

Hamstring - No further damage to the knee...easier recovery so I hear. However, loss of hamstring strength and as indicated earlier you have to keep it strong. Though I was told the loss is only 10% and not that noticeable. My doc said he wouldn't recommend it for someone with a hamstring specific job - NFL cornerback for example.

Cadaver - No further damage to the leg at all. However, possible rejection of the tissue or maybe you get a crappy ligament. I assume they give you ones from young, healthy people. If you are thinking of this one get some current figures on it, because clearly I don't know enough about it.

True about the clipless pedals and road bike shoes. My PT said no clipless for the first 6 months. I put just flat pedals on my bike and road in tennis shoes. Breaking the graft was definitely on my mind all the time...especially as I slipped on a wet floor 1 month after surgery on my crutches and my repaired knee stopped the fall. I felt a sharp pain and it was right before my architectural licensing exam (well one of the 9 sections). A highly nerve racking exam. Luckily I didn't tear the graft. Failed the test though!

I found the pool really great also once the leg was strong enough for it.

A friend once told me "God got a B on the knee joint" Maybe it should be a D though.

Hi Tony - sorry to hear that you are injured. My surgeries were both for meniscus tears, though I'm guessing any knee surgeon who can fix those is also good for ACL work. First one, 11 or 12 years ago, was done by Dr. Lindsay at University Hospital (affiliated with CU) in Denver. He cut on the CU football squad, and seemed very knowledgeable to me. He elected to repair my meniscus tear rather than remove it, because I was young (30), and he felt it would be best for me to keep all my cartilage at that point. So it got stitched, and I was back on the rock in 6 weeks, and back to feeling normal in 1 year. Injured leg atrophied much more than I would have expected with only 1 month on crutches, so be ready for some long PT sessions to rebuild muscle mass. I got back to about 95% range of motion. Stopped PT after 4-6 weeks and just did it on my own.

Second surgery was done by Dr Cavanaugh (Cavinaugh?), a well-known and respected surgeon in Longmont. (He also has a son, Kevin, who is a doctor; you won't mix them up because Kevin doesn't do knees). He's not at Longmont United Hospital, but at Pike and US 287 (Main St.). Dr. C had reached the milestone of 3000 or 4000 knee surgeries (can't remember which, but at that point it doesn't matter) in the summer he did mine (July 07). I felt very good about my experience with him. After the surgery, he told me my meniscus blew out at the stitches, so that repair lasted 10 years; he elected to remove the offending flap. A month later, he told me to go for it, so I did, and wondered for a while (the next several months) whether I made a poor choice in jumping right back in the saddle and climbing hard. I also wondered whether Dr. C. was correct in his analysis that my knee was fine and that I could go back and beat myself up.

14 months later, I'm convinced he was right. My knee feels great. He told me it would be a long time before everything returned to normal (the scar tissue would need to break down, and tightness in my IT band would linger), and he was right about that, too. Every once in a great while my knee and IT band feel worked, but they feel strong and I'm no longer concerned at all about the strength of my knee.

Though I haven't been climbing as much in the last couple of years (not because of knee problems, but because of a busy life), I feel as good as I ever have. I did no PT for this surgery -- Dr. C. said I didn't need any if I felt like I could do it by myself. He said he'd order me to PT after a month if I couldn't show him I was capable of doing it on my own. At the one-month follow-up appointment, he said I was doing a great job rehabbing my knee, and that I should just keep doing what I was doing (weights in the basement to quads and hams, and range of motion exercises; I actually got some of the lost range of motion back this time around thanks to a game I played with my kids where they'd wail on my leg, trying to touch my foot to my butt while I lay on the ground, and it worked; I'd say I'm at 97%). I'm guessing most people who have gone through knee surgeries will tell you don't skimp on PT, and they're right. It's just that I had done enough training in my life (while on track teams in school) that I was sick of people telling me to do another workout. As long as you have the motivation to do it yourself, and your doc says you can do everything a PT can do for you, you might be able to skip some PT. But this was for a simple removal of a little meniscus flap; a PT might be essential for what you are going to go through.

Sounds like you really messed your knee up -- I would be mentally prepared for a 12-18 month full recovery time. Takes quite a while for your body to heal 100% from a bad injury, and the trauma of surgery. Good luck.

Interesting reading! I was told there was a 45 year old limit for Cadaver Tendon Donations. They just don't take any "Donor's" tissue!
Hopefully in our lifetime medical technology will allow all of us to remain active throughout our lives using our own knees.
Just really don't want to get knee replacement.

Tony, sorry to hear about your injury! Stedman - Hawkins in Vail. They are the best and lead the field in research as well as latest techniques / technology.

Good luck!

I tore my ACL and MCL around 5 years ago. I lived with the injury (and continued to stay active) for over a year. I would not suggest this because I developed severe arthritis in my knee as a result.

Anyway, it took me around 8 months of intensive rehab (I had to sleep on my back for two months post op with my knee in a mobility machine). However, after many months of continuous rehab/workouts, I felt that my knees and legs were stronger than they had ever been before.

In the several years following surgery, I would wear a customized knee brace whenever I was partaking in a high stress activity. Nowadays, I can pretty much do anything I could before without even wearing a brace (I did, however, give up the one activity that was hardest on my knees, basketball).

I hope your situation is more favorable than mine was. On the plus side, physical therapists are usually quite attractive (mine was).

My surgeon was Rocci Trumper at the Orthopedic Center of the Rockies. He is an ACL reconstruction expert and I would highly recommend him.

Hey Tony,

Sorry to hear about the knee - that's terrible. Like Bernard, my only experience is with a recent meniscus tear which I just recently had fixed. This is rather minor compared to the damage of tearing an ACL; I am feeling almost 100% after 3 weeks whereas I recall my wife, who tore hers about 10 years ago, was still in a leg brace that inhibited any mobility at this point. In her case, the surgeon used the patella tendon to fix her ACL. She had to go back in in a year to have the knee cleaned up (i.e. scoped), but since that point the knee has been pretty good to her.

I will go ahead and second what Jason said - get this fixed as soon as possible. The longer you wait, the greater the possibility of scarring the articular cartilage on the end of the tibia or femur. Scarring leads to arthritis which will ultimately lead to knee replacement. And I suspect that if the recovery time is long for the ACL, then the recovery time for replacement is ultimately longer.

Anyway, best of luck. Your active, young and in good shape so I know that you will recover quickly.

Cheers, m

Tony,
that sux, but good news is they can rebuild you! sounds like maybe you had a total dislocation tearing all the major ligements? In my case, had an acl repair done with the hamstring tendon. about 6 mo recover time. strong as ever now. this guy did my surgery: fro.com/pages/doc_rahill.php ...in the same office as Pak who was mentioned earlier. As others have indicated, a good PT program is critical to regain full function.

Tony,
John Pak has repaired a torn labrum (serious shoulder injury) and done a knee scope for a torn meniscus for me as well. I have worked in Denver and Co. Springs as a R.N. for 17 years. I would be happy to introduce you to Dr Pak or Dr Rahill if you want, I see both of them all the time at the office (Recovery room nurse). Pak was my pick here in the Springs just due to my history with him, he is a good man and a red hot knee/ ortho. surgeon. Rahill also does good work and is a very active climber. James Muffly in Denver would be my choice for you if you want to stay local, he does great work and also is just a nice man. Also a reminder, rehab is huge but you probably know this from all your other dings. Good Luck and get in touch if you want any help.
Tom

OK...
A few more questions. Does anyone have any experience with Dr Cooney at Front Range Orthopedics in Longmont? He was doing research at the Mayo Clinic on joint reconstruction and replacment around Y2K. Seems like a pretty good doc when I saw recently had a cosultation with him and was a good communicator. Regardless, I'm planning on getting 2 opinions.

And What about wrist surgeons- I have some lingering wrist issues from this past winter that I might as well address at the same time. I've been putting it off until winter.

No beta, Tony. Just here to say sorry about your injury. Best wishes for a fast full recovery.

Tony Bubb wrote:What about wrist surgeons- I have some lingering wrist issues from this past winter that I might as well address at the same time. -Tony Bubb

Tony, your last comment reminds me of a good friend of mine who showed up to a climbing gathering at Devils Tower years ago. He was recovering from: a knee surgery, both big toenails removed and a vasectomy - all of which he had done within a few days of each other. And he climbed a little!

Tony Bubb wrote: Thanks for reminding me- maybe I can have the toe fixed too. That's been gettign worse for a few years now and I can't wear tight shoes anymore.

LOL - might as well get as much done at one time as you can stand!

Wrist surgery I have had some experience with! Ken Duncan in Fort Collins is a rock climber and wrist surgeon, unfortunately he wasn't on my insurance plan (is he this Mtn Proj member: Ken Duncan ?). Philip Heyman in Denver operated on my wrist in 1996, and I've been very happy with the results.

Stedman's reputation precedes him. Not sure if he has clinics in CO. I had my ACL rebuilt by Kerlan Jobe, who are based in LA but may have other locations.

I know some people frown on the patellar graft, but I've had one for 20 yrs. It's held up fine with only one incidence of tendonitis.

Fat Dad wrote: I know some people frown on the patellar graft, but I've had one for 20 yrs. It's held up fine with only one incidence of tendonitis.

OK, Paul mentioned tendon sensitivity on the Patellar, and it sounds like you've had minimal problems... what about sensitivity afterwards?

And comments on hamstring problems after using hamstring?