Talk Tennis

Talk Tennis (http://tt.tennis-warehouse.com/index.php)
-   Health & Fitness (http://tt.tennis-warehouse.com/forumdisplay.php?f=18)
-   -   ximian's ACL reconstruction journal (http://tt.tennis-warehouse.com/showthread.php?t=333684)

ximian 06-16-2010 11:30 AM

ximian's ACL reconstruction journal
 
Hello everyone. I had the unfortunate pleasure of tearing my ACL about 4 weeks ago playing basketball. 10+ years of tennis with no hint of knee or ankle problems, then one month of basketball and here I am with a blown ACL. Don't do drugs, and don't do basketball kiddos!

Anyway, I'm going to chronicle my ACL surgery and physical therapy journal here since I'm sure I'm not the first and won't be the last tennis player to deal with an ACL tear. A little about me:

Pre-injury stats:

Age: 24
Height: 5'11"
Weight: 160
Body Fat: < 10%
Playing level: Collegiate / Open Level

Injury details:

Clean ACL tear with the characteristic bone bruise. No Meniscus or MCL / PCL damage. I was on a fastbreak, and tried moving left and jumping off to the right to avoid a charge. As I jumped up I felt a pop down the right side of my right knee and hit the deck. Ice was on the injury literally 20 seconds after it happened. Just a dull pain, no swelling, and almost all ROM (range of motion). Next day there was a little bit of swelling, still no significant pain, just a dull throbbing feeling.

I visited an OS and he ordered an MRI. After a few weeks of waiting for insurance and such I took the MRI and got my results two days ago. Leading up to the MRI I was in a knee immobilizer when walking around or doing anything active.

Goals:
Regain 100% confidence in the right knee. Take as much time as the knee needs to be completely rehabbed and strengthened. Then work on tennis and getting back into game shape. Tentative schedule puts my first time back on court likely around December / Jan.

Currently I'm shopping for a good surgeon and have two great options to choose from. I also need to decide what sort of reconstruction I want. I'm pretty sure a cadaver is out, so I'm trying to decide between a hamstring graft or patella tendon graft. I'm leaning toward the latter, and will make my final surgery and surgeon decision this Friday.

Wish me luck!

surfsb 06-16-2010 11:48 AM

That's like verbatim what happened to a friend of mine playing basketball. But he also tore the meniscus. He also went with a graft (and took longer than original estimates to recover) but I hear a cadaver is the better choice if you want a faster recovery.

onehandbh 06-16-2010 06:01 PM

Sorry to hear about the injury! The good thing is that it happened to you
in your 20's rather than in your 70's so you'll heal faster. Check with the
Portland Trailblazers to see if they have any recommendations on surgeons.
Knee injuries are pretty common in basketball. Many of my friends that have
played basketball for 10+ years have had major knee and/or ankle injuries
at some point.

Thanks for making a chronicle of your recovery (and search for a surgeon).
Have a speedy and full recovery.

fantom 06-17-2010 03:00 AM

Best of luck to you. I had ACL reconstruction about 2.5 years ago. You are doing the two things that I always recommend. Carefully pick your surgeon and graft type. From there, just make sure you follow the rehab protocol 100%. It gets monotonous, but it's important!

chollyred 06-17-2010 04:27 AM

My brother tore his ACL swinging an easy 7I at the driving range. He opted for the patella tendon graft and did all the rehab. He did lose a slight bit of range of motion, but plays golf and tennis at a pretty high level (A4 ALTA Champions in 2008 ).

Sorry you're experiencing this. Knee injuries aren't fun. I injured mine three seasons in a row playing softball and spent six, eight, and twelve weeks in therapy. I have an attic full of crutches and knee braces to show for it. My wife made me swear off softball (but I still get to play tennis :) ). I never tore the ACL, but stretched it badly. When it snapped back into place, it formed a huge knot on the tendon. When reading the MRI, the doc thought it was some sort of tumor, only to get in there and find nothing but arthritis and gout.

Best wishes for a speedy, total recovery!

ProgressoR 06-17-2010 04:37 AM

i had my ACL reconstructed a while back, i was about 23, back in '94. Had patella graft. Rehab was long and hard, and i got bad advice along the way, so needed another (eventually) 2 clean up operations.
But after about a year, i played all sports, and still do, no problems. ROM is restricted at the extreme, i cannot touch heel to butt, but strength is about the same as other leg, after hard work outs or exercise, its a bit sore. But has not stopped me doing anything, like snowboarding, surfing, soccer, cricket, and recently tennis.

Best of Luck.

OldButGame 06-17-2010 11:48 AM

Quote:

Originally Posted by fantom (Post 4772788)
Best of luck to you. I had ACL reconstruction about 2.5 years ago. You are doing the two things that I always recommend. Carefully pick your surgeon and graft type. From there, just make sure you follow the rehab protocol 100%. It gets monotonous, but it's important!

Couldnt agree more with this,....Had The ACL blown myself,....(no surgery...went pure rehab route),.....The physical therapy and rehab is VERY important!!!!!....and something You probably will want to pay attention to for the remainder of Your tennis career. (eg take a few of the primary physical therapy exercises to do periodically to keep the knee healthy and stable).
Good Luck!!!!!!!!

onehandbh 06-17-2010 11:56 AM

Curious if those of you that had knee injuries were overweight
or carrying extra weight at the time of the injury?

Basketball seems to be like a wrecking ball for knees & ankles.
I've been lucky to only have 2 major ankle injuries from it.
Pretty much stopped a few years ago and decided to play
tennis again instead b/c I didn't want to risk getting gimpy again.

OldButGame 06-17-2010 12:31 PM

Quote:

Originally Posted by onehandbh (Post 4773958)
Curious if those of you that had knee injuries were overweight
or carrying extra weight at the time of the injury?

Basketball seems to be like a wrecking ball for knees & ankles.
I've been lucky to only have 2 major ankle injuries from it.
Pretty much stopped a few years ago and decided to play
tennis again instead b/c I didn't want to risk getting gimpy again.


Yeah,...i've always been in very good shape,...and lean,....but about 30 years ago i was playing basketball,....planted a foot,..tried to pivot,....foot stayed....body pivoted,....ACL..."POP"!!!!!!!,......got better ...no big problems till last fall,...blew it out again...(doing some wifes 'honeydo' list,...:mad:...)....this year im playing tennis in a brace after doing physical therapy all winter.

couch 06-17-2010 07:40 PM

Quote:

Originally Posted by onehandbh (Post 4773958)
Curious if those of you that had knee injuries were overweight
or carrying extra weight at the time of the injury?

Basketball seems to be like a wrecking ball for knees & ankles.
I've been lucky to only have 2 major ankle injuries from it.
Pretty much stopped a few years ago and decided to play
tennis again instead b/c I didn't want to risk getting gimpy again.

Never been overweight in my life and tore my acl while playing basketball about 12 years ago. Some guy just took me out in a YMCA league while on a fast break. I promptly retired from basketball!!:evil: I had more sprained ankles and knee injuries from basketball than any other sport.

I was 28 when it happened and I ended up going the patella tendon graft route and used one of the University of Louisville's team physicians to do the surgery. I followed my rehab to a "T" and continue to workout and stay in great shape and, knock on wood, haven't had any trouble since.

Since you are young and in good shape my advice would be to go the patella tendon graft route. It's a harder and longer rehab but I think it's still the best and longest lasting graft. Also, make sure you follow your rehab to a "T". I think the biggest mistake people make is going too hard too fast. Take your time and you'll be glad you did.

Keep us updated on your decisions and progress. Good Luck!!

surfsb 06-19-2010 04:58 AM

I talked with my friend and he said the reason he didn't do a cadaver is because it was going to cost $2000 out of pocket. However he said the graft was botched because they took it from the hamstring and that it was too short so they had to take it from the patella tendon. He said he feels less power comparatively pushing off with that knee and that he can also feel the scar tissue inside where they took it off the patella.

ximian 06-20-2010 01:36 PM

Thanks for all the encouraging words. I'm going to give an update, and chronicle my Surgeon and graft choice options. Surgery should be in a week or so!

To date I've visited with four different Orthopedic Surgeons, and I'm glad because I've gotten four different opinions.

Graft Choice

3 of the 4 were strongly against a Cadaver since it's not my own tissue, and there is a greater chance of re-tearing it. One of the surgeons explained that it should also be a longer rehab, since evidence suggests your body needs to fully accept and transform the tissue, which takes a few months longer. However, during that time the ACL will feel fine, and so there's a tendency to rush the rehab.

3 of the 4 also suggested a Patella Tendon graft, considering it's probably the "best" graft. The firmest and tightest one available. It's also a bone to bone graft, which is preferable.

However, one of the surgeons, whom I picked to do my surgery (more on that later), advised me to reconsider the Patella tendon. There's approximately a 10% chance I would develop Patella pain down the road, and if that happens there is nothing to stop / prevent it. It's just something I would have to deal with. And given my history of Patella tendonitis (I had a small case of jumper's knee in my left (non injured) knee two years back), I need to reconsider this risk. Developing Patella pain would not be fun, and the OS said there's really not much I could do to prevent it. Even with a perfect rehab, it would either develop or it wouldn't.

Added to this is the fact that tennis is specifically intensive on the Patella tendon. I remember from my jumper's knee bout that it can really be a pain to deal with. This would likely just increase any chance of Patella tendinitis or Patella pain. That's not really something I want to risk.

All 4 said a hamstring would also work well. One of the OS's I saw is the surgeon for the University of Oregon athletes, and he will often let the athlete pick which graft they want, since their success rates are similar. Only for certain athletes would he specifically advise one path over another. The difference between a Patella graft and a hamstring is mainly an increased laxity with a hamstring graft. It can stretch a little more than a Patella and become a little loose. So often for athletes its a better idea to go Patella just to ensure a snug, tight graft. On the flip side, the hamstring is a stronger graft, but that is not that big of a deal.

However, through visiting these OS's, I've been informed my ACL is naturally a little loose. And this is not necessarily a bad thing. First off, an ACL that is too tight causes more problems than something that is too loose (increased chance of arthritis). The only real concern with an ACL that is too loose would be an increased risk of tearing the meniscus. Additionally, building up the quads, hamstrings and calf muscles will minimize the "damage" a loose ACL could inflict. So really, a loose ACL would not be that big of a deal.

Finally, if I follow my rehab to a T and don't rush it at all, it will give the hamstring graft time to fully "graft" with the bone and become tight. After 6 months, the chances of the hamstring graft stretching or becoming a little more loose are drastically reduced. So provided I follow my PT regimen perfectly, the issue of a loose ACL with the hamstring graft is minimized. And the "issue" really isn't a big deal anyway should it happen.

Considering all this, I'm leaning toward doing a hamstring graft. I just don't want to take the chance with Patella pain, even if that graft might be a slightly better option for an athlete.

Surgeon

Of the four OS's I visited, 2 were general surgeons without a stellar resume, while the other two were Sports Science surgeons. Dr. Hoellrich was one, and he is the surgeon for the University of Oregon athletes and works out of a very well respected clinic in Eugene Oregon. Dr. Bollom is the other, and he is also a Sports Science surgeon and likely has the most experience with ACL reconstructions in all of Oregon. Furthermore, he previously worked with the Denver Broncos, Colorado Rockies and the U.S. Men's and Women's Alpine Ski Teams. Two excellent options to choose from, but I think I'm going with Dr. Bollom.

The surgery date should be set by this Wednesday, and I'm going to shoot for June 29th. That will leave wednesday, thursday and friday to work directly with a recommended Physical Therapist and begin the healing process.

Next up is to make a final decision on my graft choice, research PTs and figure out what the first week or two post-op will be like. To maximize my chances of success I'm currently doing PT to regain ROM and strengthen my right leg as much as possible. I've already seen a lot of improvement in one week, and I think I'll be in ideal shape going into surgery.

Wish me luck!

couch 06-20-2010 06:31 PM

ximian- sounds like you've done your homework. I definitely agree with everything you posted. Sounds like the hamstring graft might be the best option for you given your past problems with jumper's knee.

Either way, I think the surgeon and your rehab is going to make a big difference in your long-term success. Sounds like you are headed down the right path.

Good luck!!

fantom 06-21-2010 03:16 AM

ximian,

You did yourself a huge favor with all of the research and surgeon interviews. Way too many people just do whatever the first surgeon the speak to tells them.

Good luck!

ajmack 06-21-2010 08:26 PM

ACL surgery 20 years later
 
I commend you on getting a number of opinions. This is obviously an important decision. You want to be comfortable with the surgeon and the procedure.
I was in high school in 1990 when I also blew out my knee playing basketball. I wasn't in great shape, but definitely wasn't overweight either to address one post. Anyway, I had the patella tendon graft and wasn't given another option. The cadaver procedure was very new at the time.
The rehab was long and difficult. I had a pronounced popping in my knee that eventually required arthroscopic surgery to clean out scar tissue.
I lost some range of motion and jumping ability, but was able to return to sports with the help of a brace fairly quickly after the second surgery.
In the 20 years since, I've played competitive softball, taken karate for two years and just started playing tennis again last year (now at the 4.0 level).
My gait remains slightly off due to the injury, but I have no real problems with the knee. I play tennis three tiimes a week and haven't worn a brace since high school.
Interestingly, I was recently told by a prominent local orthopedic surgeon that my PCL was torn. He could tell by the alignment of my fibia and knee as a sat down.
This wasn't conveyed to me 20 years ago. It's not worth 'fixing' if it isn't a problem, according to the surgeon.
Like others have said, follow your rehab religiously but don't overdo it.
Hopefully, my situation and experience from the injury 20 years ago gives you some comfort.
Good luck.

ximian 06-30-2010 12:46 AM

Thanks for the encouraging words!

Surgery is tomorrow!!

I'm not nervous, just anxious to get it over with and begin my rehab and get healthy. This whole thing already feels like its been awhile. And it has I'll have surgery almost 6 weeks to the day after the initial injury.

A few notes:
  • I've decided to do the hamstring graft. My surgeon should be very capable and ensure no extra laxity (my only real concern).
  • I've been doing A LOT of PT since I got the results of my MRI. About an hour every day actually. 30 min biking, followed by various leg strengthening exercises outlined by my physical therapist. I've been upping the number of sets as I feel comfortable as well, and right now I have all but 10* ROM and my strength is pretty good. The knee actually feels semi-normal, even though it still feels like buckling and there are twinges of pain here and there.
  • In addition to the PT, since I've been in the gym every day I've taken it upon myself to do some extra cardio and some extra weights. I mean, why not? I'm in the gym, lets make use of it. On a four day cycle, I swim a pretty rigorous set (no kicking of course) one day, do a complete upper body workout the next, then a rest day, then swim again and start the cycle over. I hope to use this rehab period to get into some great shape and to learn about nutrition and taking care of my body. When life gives you lemons....
Anyway that's a quick wrap. Wish me luck for my surgery! I'm gunning for the end of December to get back on the courts.

BillH 06-30-2010 10:32 AM

Good luck with your surgery! - I had a hammy graft in right knee in 2002 and hammy in left knee in 2004. Both surgeries required 1 year of wearing a brace post surgery during sports and about 2-3 months of formal PT and another 3-4 months of self supervised PT. In both cases, it took about a year before I felt I was 100% on the tennis court. Also keep in mind the studies show that after a couple years both graft types have similar strength ans only slight differnces in laxity. As everyone else said, do your PT religiously and you'll be back playing tennis in no time. Also, make sure you use a passive movement machine and cryro cuff in the days immediately folowing surgery - their use will greatly reduce swelling and pain and get your ROM back sooner.

kslick 06-30-2010 01:34 PM

Good luck!!! Nice to see the positive attitude...that will take you far!!!

couch 06-30-2010 05:39 PM

Good luck ximian.

fantom 07-01-2010 03:53 AM

Best of luck! Stay on those meds and the pain won't be bad.


All times are GMT -8. The time now is 10:35 AM.

Powered by vBulletin® Version 3.6.9
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
© 2006 - Tennis Warehouse