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Old 06-20-2010, 02:36 PM   #12
ximian
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Join Date: Oct 2005
Posts: 316
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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!
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