Yet another torn ACL post...

Dwake1 · Newbie Joined: 18 Apr 2011 Posts: 4 City: Orlando

Hello all,

So, I've read all the other posts dealing with this issue, and got a lot of good info from them, but I wanted to start a new thread with a few questions I didn't see elsewhere.

I just recently (a month ago) destroyed my ACL snowboarding in Germany. Right as wake season is about to start! So obviously I'm trying to find out as much as I can about the surgery, PT, and what I can/can't (or should/shouldn't) do in the meantime. Quick rundown:

ACL completely done, but nothing else as far as I know. Still haven't had my MRI looked at by a competent doctor over here. I'm actually waiting on the VA to approve my surgery, as this happened on my last two weeks of active duty in the navy. In the mean time, I'm exercising it as much as possible, not wearing a brace to ensure I don't let any muscles atrophy, and actually even hopped up on my board a week and a half ago for an admittedly simple and soft run. So here's where I was hoping to get some help from the forums:

First, what are everybody's personal experiences with the different types of replacement surgerys? After my first few days of web research, I was leaning towards the hamstring surgery. Then I talked to a couple of people in the wakeboarding world (especially a very helpful dude at OWC), who made me think that the cadaver replacement might be best for several reasons. Thoughts?

Secondly, any good recommendations for surgeons in the Orlando area? I'm pretty sure the VA has to fee base this out as too complicated for them, and I'm really hoping my request has a say in the matter.

Finally, any good recommendations as far as activities to do both pre and post op to get back into riding shape (outside of PT)? I've seen bike riding recommended on the forums, but anything else to keep from getting terminally bored? An endo board seems like a good idea to me.

Other than that, any random advice is greatly welcomed. I'm thinking of doing a bit more wakeskating right off the bat, as there is no terrible toe edge to plant.

Anyway, thanks mucho for any and all suggestions!

LaynDoor · Outlaw Joined: 26 Feb 2010 Posts: 152 City: Meriden CT

Well, i could almost write a book on the subject... Torn ACL, PCL and two torn menicus... 2 different surgeries by age 23....

to answer your questions the best I can (im sure others may have different opinions)
- i would stay off a board, or anything else that puts lateral stress on the knee joint, untill you have your surgery... too much impact on the knee without an ACL could very easily result in a torn meniscus (i know from experience)... and there is no way to repair a meniscus besides cutting out the torn piece... dont get me wrong, you need to strengthen that knee, but stay away from high impact sports... and schedule your surgery asap so you can get back to sports with a repaired knee rather then delay and try and do stuff with a damaged one.

-Patellar tendon is the way to go... The spot they cut the graft from takes a long time to get back to normal... Hammy wouldnt be my first choice to take the graft from for that reason...

- Cadaver is dead tissue... Your own tissue should always be the first choice unless for some reason you cant... for my PCL repair my ortho wanted a really long graft so he could get it as tight as possible... so i used a cadaver (they dont care how much gets cut out of them)... but for my ACL it wasnt even a discussion... Patellar tendon all the way.

-Dont know anyone in orlando... but make SURE you get an ortho that specializes in sports medicine... They understand what your end goal is (get back to playing sports) and will treat you appropriately...

- Its really hard to understand unless you have had joint surgery... but you are going to lose alot of your range of motion as a result of the surgery... PT will put you on a stationary bike right away... but not as a work out... I doubt you will even be able to get the pedals around one full rotation for the first few days.... bike is mainly to stretch and get your range of motion back... once you get your ROM back, light squats, leg extensions, lunges and balance drills (one legged)... stay off a board untill your knee feels stable.

- you didnt ask, but when your ready to ride again WEAR A BRACE! Wakeboarding is like no other sport... when the water grabs that board you have ZERO time for your leg mucles to fire and protect the knee (which IMO is why there are so may torn ACL's in wakeboarding)... I play hockey and baseball, I snowboard and wakeboard.... the only one i wear a brace for is Wake... your knee is just so vulenrable in watersports.

Good luck and get the process started! I delayed my ACL surgery for almost 9 months and i regret it big time.

Let us know how you do,
Jon

9DROZD · Outlaw Joined: 21 Apr 2010 Posts: 114

As far as Hammy vs Petellar, theres no evidence that shows either one worse than the other in the long run.

Hammy: Pros: Can kneel after, quicker to start rehab and less pain
Cons: Takes longer to heal bone to graft

Petellar: Pros: Overall quicker recovery and return to sports
Cons: Uncomfortable when kneeling after. Little more painful as far as going through rehab.

Either one will be fine. Go with what your Dr. prefers because thats where your going to get the best results. Im 8 months out with Hammy graft, 4 repaired tears on meniscus, and a micro fracture. Im just about ready to get back to boarding and cant wait.
Good luck.

Chattwake · Posted: Apr 19, 2011 6:04 am Post subject:

I had a hammy graft. In hind sight, I would have done the patella graft. 6 years out and my hammy is still at 95%. I work out a lot. I had to do a ton to get my right quad and hammy back to close to even with my left leg. I had a friend who got a patella graft the same weekend as my surgery and his recovery was slower at first, but he is at 100% now. Just my .02. Oh, and don't expect to ride, surf, or do anything involving cutting or impact for 9 months minimum if you want your graft to hold.

mseller · Outlaw Joined: 05 May 2010 Posts: 220 City: Charleston

I tore mine last july and am 8 months past surgery at the moment...I got the petellar graft...i've been doing riding/activities for the past month(prob a little too much)...my quad is not 100% yet and I still feel my knee twerk every now and then...however my knee feels very solid according to the doc so i guess it's just part of the rehab

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

All of the docs at my practice use allografts (cadaver) that way post operatively your body only has to heal where the ACL reconstruction is performed and not a 2nd location (patellar or Hamstring). Post operatively guys/girls are able to return to running around 4 months and likely return to higher impact activities around 6 months.

Pre-op you want to be sure you have full range of motion as your pre-op ROM is the best determinant of post op ROM and how easy it will be to get your ROM. You also want to get your leg as strong as possible with quads being your target muscle group. After your surgery you are going to experience massive atrophy of your whole leg but quads will be the worst. The swelling in your knee joint itself will inhibit quad function which makes your quads go on vacation for a while.

Post op be careful! The brace will be your option 8-12months post op but before that be religious with that brace. Everyone hates it but it is for your own protection. Your new ACL will be very fragile for the first 3 months (we call the 2-3 month stage the dead fish stage where it is super fragile) so just be careful!

Good luck!

TheHebrewHammer · Addict Joined: 03 Dec 2010 Posts: 526

Jesus guys, this sounds awful. Good luck to you all. Not to hijack the thread, but is there anything I can do to prevent a knee injury like this? I've been riding a lot more and a lot harder lately and I don't want to expose my knees to unnecessary risk.

LaynDoor · Outlaw Joined: 26 Feb 2010 Posts: 152 City: Meriden CT

pat8839, No issue with cadaver ligaments stretching over time? Ever had someones body reject the tissue? Just wondering.

TheHebrewHammer, Pray... lol... no way to absolutely prevent it... Wakeboarding is one of the worst sports for knees that I know of... but you certianly can reduce your chances... dont try and ride above your ability and learn tricks in the proper sequence (easier said than done)... and IMO, ride a flex board... wont stop you from catching an edge, but soooo much easier on the landings... I rode my buddys Lyman last year... NEVER again... my knees just cant take the impact and I need to walk into work every week... lol

TheHebrewHammer · Addict Joined: 03 Dec 2010 Posts: 526

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

ericsoler · Newbie Joined: 12 Apr 2011 Posts: 18 City: Lake Stevens

I got my surgery done two months ago and I had a patellar it hurts and hurt terrible bad. just saying be prepared for extreme pain.

shonuff · Criminal Joined: 23 Aug 2010 Posts: 58 City: Atlanta

I was under the impression if I worked out my legs to keep the muscle around the knees strong it would help against tearing ligaments. Am I wrong?

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

TheHebrewHammer · Addict Joined: 03 Dec 2010 Posts: 526

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

When it comes to baseball pitchers they are prone to injury due to the imense amount of torque at the inside of their elbow that with the repetitive motion of pitching over and over leads to gradual breakdown and then total tear of that UCL.

Ligaments get stronger as a result of the forces they are put through so that they may be able to handle that stress-pizoelectric effects and Wolff's law yada yada...Torque is a different animal though! When you add in HGH and a little vitamin S your ligaments cannot keep up with the massive growth of the muscles which will then lead to easy ligamentous tears...

LaynDoor · Outlaw Joined: 26 Feb 2010 Posts: 152 City: Meriden CT

mseller · Outlaw Joined: 05 May 2010 Posts: 220 City: Charleston

I tore mine on a standard w2w jump...i was shocked Rolling Eyes

cletis · Outlaw Joined: 26 Jun 2003 Posts: 181 City: Oshawa, Ont.

As far as the graft it really depends on the surgeon. You don't want your surgeon doing something he isn't comfortable with. If you can get patellar tendon graft that's what i prefer my patients get. My reasoning is simple, when i'm rehabing an ACL you want the quads to be as strong on the injured leg as the good leg in the end. With that being said the most important thing for protecting the ACL in the future is building hamstring strength as much as possible. When you bend and straighten your knee the femur and the tibia slide on each other. When you flex, the tibia slides back on the femur, when you extend the tibia slides forward, with out this sliding your knee can't bend. When your extending your knee and the tibia slides forward, the ACL becomes taught and stops the tibia from sliding right out. Your hamstrings slow down this sliding before it reaches the end of extension. The stronger the hamstring the better it works on controlling this motion. If your hamstrings are week, the more work your ACL will have to do to control this motion and stop extension at end range. If you do a hamstring graft you are inherently weakening the hamstrings. From my experience people with hamstring grafts always struggle to get 100% of their strength back.

As far as preventing knee injuries the stronger you can get your overall knee strength the better. You just don't want to do straight line strengthening, you also want to increase dynamic strength.

supremelandingmaster · Newbie Joined: 18 Apr 2011 Posts: 10 City: Kingston

been there. but you're in luck (not really considering you tore the ACL). the best ACL doc on the whole planet is in Florida. He comprehends orthopeodic surgery on another level. Widely recognized by the pro sports community as the best. Dr. James Andres

~Andrews Institute for Orthopaedics & Sports Medicine in Gulf Breeze, Florida. Dr. Andrews is arguably the most renowned orthopedic surgeon in his profession for knee, elbow, and shoulder injuries.[1][2][3] He has also been credited with performing some of the earliest arthroscopies.[2] Some of the most common procedures performed by Andrews are Tommy John Surgery and the repair of knee damage, and generally he is considered a top specialist in repairing damaged ligaments.
_____________________
http://unitwan.co.nr/f1.htm

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

Andrews also founded the SLAP...just a bit of trivia haha

Dwake1 · Newbie Joined: 18 Apr 2011 Posts: 4 City: Orlando

Wow, lots of good info and advice so far. Thanks to all!

So what I'm seeing here as far as recommendations to which type of graft is kinda what I've found up to this point online and in talking to other: really the best options are the patella and the cadaver, each for their own reasons. I get that the cadaver can be weaker, but it seems that the speedy recovery and the fact the you won't have problems with the patella later might outweigh the weakness. Anyone out there have personal problems with the cadaver they can share?

Thanks mucho for the recommendations on specific surgeons; hopefully the VA will let me choose who to go with, not just sign me up for surgeon slice.

Again, thanks for the great advice, and please keep coming with anything else you can think of. Good riding!

pat8839 · Outlaw Joined: 18 Mar 2010 Posts: 106

Just to check in, how is that knee doing? Keeping the swelling down, and getting your range of motion back pretty easily? You will do yourself a big favor if you can control these 2 issues prior to surgery.
Good luck!

jbcs16 · Outlaw Joined: 03 Aug 2010 Posts: 100

Reading these posts make my knees hurt!!! This is my first post to the general discussion here, but I enjoy reading. I had my ACL reconstructed in 2000 and used my hamstring to make the new ligament. I would not recommend using the hamstring. I had a difficult time getting full range of motion after surgery, especially extension and 10 years later I don't feel like my knee is 100%. I was only 22 when I had the surgery and remained very active. I have since had 3 other knee surgeries to repair meniscus. Well one was to try to repair it, but it didn't work so they ended up removing most of the lateral meniscus. I originally injured my knee in college playing softball and didn't start wakeboarding until last summer so it had nothing to do with the injury. At the end of summer I was trying a wake to wake jump and didn't quite make it across and had a hard landing. Didn't fall, but my knees took a lot of jarring. Another time, I caught my toeside edge and my board made an awkward turn as i fell. since then, i wear my brace to wakeboard. Anyone have any suggestions on making softer landing to help the knees out a little?

Dwake1 · Newbie Joined: 18 Apr 2011 Posts: 4 City: Orlando

mseller · Outlaw Joined: 05 May 2010 Posts: 220 City: Charleston

go with the defiance III http://www.donjoy.com/index.asp/fuseaction/products.detail/cat/1/id/170 that's what i'm riding with after my surgery and it gives you a lot of support...they supposedly claim if you tear your acl while riding with this they will cover the surgery

LaynDoor · Outlaw Joined: 26 Feb 2010 Posts: 152 City: Meriden CT

LaynDoor · Outlaw Joined: 26 Feb 2010 Posts: 152 City: Meriden CT

mseller · Outlaw Joined: 05 May 2010 Posts: 220 City: Charleston

jbcs16 · Outlaw Joined: 03 Aug 2010 Posts: 100

I would love to try a flex board, but don't have a lot of extra money at the moment. Can anyone suggest a place to find used flex boards or previous year boards that may sale cheaper? I'm willing to spend some money, it will definitely be worth it if it easy on the knees.

Dwake1 · Newbie Joined: 18 Apr 2011 Posts: 4 City: Orlando

Chattwake · Posted: May 05, 2011 4:58 am Post subject:

I've got a defiance III as well. Awesome brace. I ride a LF Shane because the double concave hull helps break up the surface tension of the water when you land in the flats/trough. I blew my ACL on a backroll as well back in '05. Now, the only time that my right knee really gives me problems is when I come up short and case a w2w hard. I've learned that, if I know I"m coming up short, and I hate to do it, I just drop the handle and take a soft fall instead of trying to case and ride away. Doesn't happen that much, and its my boat I'm riding behind, so I figure - who cares. Just more incentive to go big and land further out.

One hard case and my knee hurts for the rest of the day, sometimes two days. It's not worth my trying to ride away from something trivial. Now, I'll dig out my inverts like crazy!