What kind of ACL graft did you get?

August 25, 2009 6:44 PM

Did you get ACL reconstruction surgery? I would like to know as much about your specific experience and graft choice as possible, to help me decide on mine.

I am a 29 year old female in fairly good shape. I completely ruptured my left ACL one month ago playing soccer, as well as tore the meniscus and sprained the MCL. I am in PT right now, and will probably get reconstruction surgery for the ACL, definitely for the meniscus tear. I am reading all these journal articles about different graft advantages and disadvantages, and, don't know what to choose. Ideally, I would like to hear from you if you have had all 3 types of graft and can tell me exactly the pros and cons of each. Realistically, I'm not going to find that (very unlucky) person. So:

(a) how long was it between your injury and your surgery? did you do PT before the surgery? in retrospect, do you wish you had gotten the surgery sooner or later?

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc?

(c) post-surgery, what do you wish someone had told you?

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.)

Thanks. Any information is appreciated, *especially* as relating to specific graft type experiences. I'm trying to defend my PhD this semester, and this is a much unwanted roadblock. Even a week or two of not being able to work might be enough to make me miss the defense deadlines.

posted by hybridvigor to health & fitness (22 comments total)

Not exactly what you're asking for, but I snapped my PCL and decided to see how it went without surgery. It went fine, almost 20 years later, probably because I developed ways to favor that leg, like never stepping off onto it. I use my opposite ankle muscles to give a little push-off, when climbing stairs.
posted by StickyCarpet at 6:55 PM on August 25

The injury itself was painful for close to a year, OK after that. I did no PT, just half an hour on a stationary bike any time its acts up, which clears things up for at least a few months. And yes, I can predict when it's going to rain.
posted by StickyCarpet at 7:04 PM on August 25

I had patellar tendon, though it was in '96, at the age of 34. I have not kept up with advancements, developments since then.

Hamstring thing was very new at the time. I met someone who had it, raved about it so I talked to the doctor. Sounded good, though my doc thought it was too new, there were too many questions. What the heck did I know about all that?

I did know that a prominent pro football player had recently undergone ACL surgery and I managed to talk to the team's trainer, find out the player had PT surgery. Trainer thought the hamstring was too new and unknown.

I thought, "Good enough for a top NFL player, good enough for me."

Going on 13 years later, I've walked a ton, hiked a fair bit, played a bunch of golf, been sitting for 12-hour plane rides, etc., and not had problems. It can feel a bit not-right (which is sorta hard to describe, might be the meniscus tear, loss of cartilage that came with the ACL tear) once in a great while, but it's fundamentally good, coulda been a whole lot worse.

Hard to speak to advantages/disadvantages because I dunno how the other option woulda played out, but I am fundamentally happy with the PT procedure.

I'm trying to remember the time between the injury and surgery. There were a lot of pain meds so memories are hazy. Wanna say roughly three weeks to let the swelling go down, something both doctors said was the way to go, so my best sense was that it was done at the appropriate time.

Post-surgery, can't think of anything I wish someone had told me. People emphasized the value in physical therapy and I stuck with it because I was worried about atrophied muscles.

No therapy before the surgery. Maybe the thinking has changed, but neither doc mentioned it.

I was limping a bit for a couple-three months, but it wasn't bad. In the space of a couple-few days, I was entirely able to do a desk job (though I was taking pain meds, forget how long after the surgery I took them), get around on crutches, which I think I had for about a month.

You're welcome to MeMail me.
posted by ambient2 at 7:37 PM on August 25

I don't even know how long my ACL had been torn before I had it replaced. I had meniscus damage which made running difficult and they noticed my ACL was torn when they examined me. They used my patellar tendon. This was a long time ago--maybe a decade or more? My replaced ACL has since retorn.

Here's what I wish I'd known beforehand:

1) That it would be a year before I would be totally back to normal.
2) That it would be a month before I could walk without some kind of external support.
3) That my muscles in my leg would atrophy and I'd have to build them up from scratch.
4) That I'd have to fight with insurance companies to get the machine I needed (whose name I can't remember now, some 3 letter initialism) paid for. Eventually, they did pay, though.
5) That it could easily tear again.
6) That PT shouldn't be 1 size fits all. Some exercises they told me to do made things worse and others they said not to do would help.

I now live with the torn (replaced) ACL and just say "no" to surgery. I take the NSAID Mobic daily and if I don't do anything stupid (like sprint, or go skiing, or jog over 2 miles) I can do normal things.

That said, there won't be constant pain sitting in front of a computer. When not moving, after a few days there was no pain at all. Most of the pain was in trying to get my knee moving again. I still can't sit in positions that put a strain on my knee (e.g. lotus). If I take a long walk, I might have to ice my knee a bit. I can also predict rain, like StickyCarpet.

I can generally bicycle everywhere with no problems.

Also, keep in mind that I'm more than twice your age.
posted by Obscure Reference at 7:58 PM on August 25

Background: I tore (shredded, according to the doc) mine playing soccer, early 20s male in good shape.

(a) how long was it between your injury and your surgery? did you do PT before the surgery? in retrospect, do you wish you had gotten the surgery sooner or later?

A week, or thereabouts. No major swelling. No PT prior to surgery. Timing was good.

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc?
Patellar tendon. 9 months. I understood Patellar to be the best choice in my situation and have no reason to doubt that now.

(c) post-surgery, what do you wish someone had told you?

Do your fucking PT. No really, DO IT, all the way to completion. No, I don't think you understand, just fucking do it and stick with it until it's done.

I did mine for awhile, but due to quitting a job and resulting insurance issues, stopped going in early, with the intention of doing it myself at home. Yeah right, didn't happen. I am only now getting serious about returning to full strength, and it sucks.

SO JUST DO YOUR DAMN PHYSICAL THERAPY, OK?




APPARENTLY YOU DON'T UNDERSTAND. IF YOU HAVE TO HAVE SOMEONE BEAT YOU OVER THE HEAD DAILY IN ORDER TO MAKE IT HAPPEN, THEN DO SO.

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.)

I was back at work (desk job) the next week. The pain sucked for awhile (especially at night), but completely tolerable for work. I took my special ice-water circulating knee-wrap to work, and that helped. Pretty useless around the house for awhile after that, though. Maybe 3-4 weeks where it was easy enough for me to get up and get things rather than asking my poor wife to wait on me hand and foot.


AND LASTLY, DO THE PHYSICAL THERAPY!!!
posted by entropic at 8:14 PM on August 25 [1 favorite has favorites]

I blew out my left knee way back in '94 while playing rugby. Tore all three ligaments, and partially dislocated my knee because the first doctor I saw said I only had a "sprain." Took off the foam cast for a shower and was screaming in a dorm bathroom about ten seconds later.

When I finally got to a competent doctor he suggested it would be best to wait a few months for the reconstruction to avoid an excess of scar tissue. Sounded like good advice to me, so I spent about six or seven weeks with a big cast foam cast and on crutches. Being at a small mid-western college at the time it wasn't much fun. And for the first few weeks my foot was positively black from internal bleeding. Doc said this was not a problem, and apparently it wasn't.

Finally had the surgery (at the time, it was the guy who did knees for the Ohio State football team, so I felt pretty confident going in). Had a tendon graft (they do it other ways now?). Spent one night in the hospital in a fair amount of pain, sent home with a bottle of Percacet (sp?). Took exactly one pill, decided I didn't like the feeling, so just kind of gritted out the rest of it.

Worst part was the locking foam cast. I was supposed to lock my leg into a straight, non-bending position at night. Excruciating.

Got fitted for a molded plastic knee brace thingie that replaced the (by then quite stinky) foam cast. It was great, actually, and fit underneath pants pretty easily. I put that thing on and was mobile about -- god, it's been a while -- maybe one month after the surgery. It felt like it was "fast turnaround" for what it's worth.

The atrophy was kind of scary, but I was told to expect it. I was pretty good about doing my re-hab, but after a few weeks when I felt confident in getting around without crutches I probably wasn't as good as I should have been. I justified it to myself by saying "Hey, I'm walking around, the muscles will come back." And they did, but it took longer than it should have.

Played rugby again for my junior year (accident was sophomore year), and definitely was slower. Again, I didn't push myself in re-hab like I should have. Then again, I was never in any danger of being considered a really good athlete.

Fifteen years on (yikes), I still know I have a reconstructed knee. Flexibility is all there, but if I come down at a funny angle on it (I teach kindergarten, so this happens) I definitely feel a tweak or twinge. When I had access to a gym I was more into the Life Cycle than the treadmill, but running isn't a problem. I just feel like I can push myself harder on a cycle. If I'm tired, or my legs are sore, my knee does start to "act up" and hurt a little. Kind of a dull soreness.

Anyways, good luck. I'll bet the tech has improved dramatically since my surgery.
posted by bardic at 9:22 PM on August 25

To clarify, I was off crutches a month after surgery. I was mobile, albeit on crutches, about three or four days after the surgery.
posted by bardic at 9:24 PM on August 25

I tore my ACL in May 02 and had the surgery November 02. To answer your questions:

(a) how long was it between your injury and your surgery? did you do PT before the surgery? in retrospect, do you wish you had gotten the surgery sooner or later?

6 months between injury and surgery. This was a huge mistake, mostly because my injury was such that I was on crutches for two months of this time, and there was a lot of muscle mass loss. This made surgery recovery a lot more difficult. I did have PT before the surgery, but it didn't really make up for the muscle loss. I definitely wish I'd had the surgery within a month of the injury.

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc? I had the cadaver graft. I don't know much about the different options, but 7 years later, my ACL's still doing its job (knock on wood).

(c) post-surgery, what do you wish someone had told you?

I wish I'd known how long and difficult the rehab would be. I really had no idea I'd be on crutches for over a month afterwards, or how exhausting the combination of surgery and recovery would be. I pretty much went right back to work, but wasn't very productive for a while.

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.) See above - I was truly useless (drugged up) for about a week, but not really fully functional, work-wise, for about a month. You'll just be slow, and even if you work at a desk, everything is exhausting when you're on crutches and taking care not to hurt one leg.

One piece of advice: stick with the PT until your muscle mass is restored (or get a personal trainer once your insurance stops paying for a therapist). I wound up tearing some mensiscus the next summer while hiking in Montana, mainly because I was dumb and went hiking in Montana before my knee was truly stable. I still can't properly squat, which is annoying as hell.
posted by lunasol at 11:14 PM on August 25

My injury was similar to yours - I tore my ACL and tore my meniscus in a classic torsion injury when I got thrown from my bike by a car.

(a) how long was it between your injury and your surgery? did you do PT before the surgery? In retrospect, do you wish you had gotten the surgery sooner or later?

Mine was more than 3 months. I had serious swelling as well as general RTA trauma and getting surgery earlier was not an option. I did not do PT because of my living situation - I was on crutches with a stabeliser and the stairs from my upstairs apartment were a bigger risk than not doing PT.

In retrospect, this may sound stupid but in the period between the accident and surgery, I wish I had paid more attention to not gaining weight. You will have to carry every pound fully supported by crutches and the more you weigh, the more cumbersome that process is.

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc?

I had an allograft and have no regrets. It's been about 10 years. Honestly, not to scare you, but I have pain in my knee and the idea of having other points of pain is something I would opt to avoid at nearly any cost.

(c) post-surgery, what do you wish someone had told you?

1) That you will need help - a lot of help, more help than you realise. You can stand in the kitchen and make a cup of tea, but if you are totally dependent on two crutches, you can't carry it anywhere. It's very frustrating.

I got the help I needed from a friend who came by every day after work and a nurse who came 5 days a week for 2 hours for a month. People rand errands for me. I got my groceries delivered.

2) That escalators are fast. Very, very fast. So much faster than you ever realised.

3) That you will only be able to have sex on your back for months and months.

4) That PT is the golden ticket and that hydrotherapy - even just walking in water - is 10x more useful for regaining range of motion and building muscle than the stationary bike ever will be. (Do both.)

5) That even though your disability may be temporary, you are legitimately disabled for the duration and it is 100% OK to demand the world accommodate you. Get the mall to stop the escalator for you if there is no elevator. Borrow the scooter at the grocery store and if they offer you a personal shopping assistant, take the help. Get wheelchair assistance at airports. Borrow a wheelchair from the Red Cross for anything like a graduation that requires you to traverse a football field. be prepared for pitfalls you never considered before, allow yourself time to deal with the unexpected, and ask for help.

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.)

Yeah, see, I think you're not getting it. Maybe other people will have had different experiences but after the first week, it isn't the pain - it's the exhaustion. Being in pain is exhausting. Dragging your body weight around is exhausting. The commute that takes twice as long because you are so slow is exhausting. The long walk to the office bathrooms or kitchen is exhausting.

On top of that, you cannot physically sit at a desk for 8 hours post-op. You will need to elevate your leg during recovery, even after you've regained excellent mobility. This makes a desk with a solid panel rear impossible. See what you need when you are ready to go back to work, but remember that "reasonable accommodation" is your friend.

All in all, I was utterly useless for a week, barely able to care for myself for the second, and then a very slow 8 week plateau to full mobility with a walking stick. I am pretty sure I did no office for a month and then half days for a while.

PS: Learn to knit! And get a lap desk for a laptop! And Netflix!
posted by DarlingBri at 11:39 PM on August 25 [1 favorite has favorites]

DarlingBri's comment reminded me of a few other things:

you are legitimately disabled for the duration and it is 100% OK to demand the world accommodate you.

This, definitely. Also, I totally forgot about how scary escalators were after my surgery. Get a friend to help you the first few times you go on one.

Also, people don't talk about this very much for some reason, but anecdotally, post-surgery depression seems pretty common. I imagine it has a lot to do with the exhaustion and the pain, but also, having a part of your body replaced can be fairly traumatic, and it can be depressing to be physcially frail. You might not experience this, but if you do, know that it's normal and it will definitely pass.
posted by lunasol at 11:55 PM on August 25

I snapped my ACL skiing in 2006, had the surgery in late 2007. The reason for the delay was that I had a year's trip to S America booked and the surgeon said no problem, you'll just have to build up the muscle and have a dodgy knee.

(a) how long was it between your injury and your surgery? did you do PT before the surgery? in retrospect, do you wish you had gotten the surgery sooner or later?

So, a year and a half between the accident and the surgery in retrospect was no problem. It meant that the muscle wastage due to the 4 week immobilisation immediately post-accident was pretty much dealt with by just walking around for a year.

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc?

I had the hamstring graft, done by a fairly new keyhole process which left me with a couple of tiny (2cm and 1cm) scars and no need for painkillers immediately post op. The surgeon was a skier and apparently v well regarded over here in th'UK. I've had no post op pain, no problems with the knee and am back skiing (in late 2008 I had my first go and it was fine).

(c) post-surgery, what do you wish someone had told you?

Do the pre-op physio, do more, build up your stabilising muscles, get a wobble board and use it... do the post op physio... really do it... then do it some more... maintain your general fitness any way you can.

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.)

I was useless for a week, sitting at a computer after that (with a raised leg) and driving after three and a half weeks. I would say back to normality after three months but not completely fixed for a further three or four.
posted by itsjustanalias at 12:19 AM on August 26

Having related thoughts before, I am struck by how big the challenges have been for some people.

If possible, perhaps best to delay this 'til after your defense?

I was up and at it much faster than at least one other person in this thread--discomforted, though functional at a desk job and driving a couple days after the surgery. I'm not unusually coordinated, but elevators were easy. I was not depressed at all; rather, I was upbeat, happy to have had the thing fixed and be getting better.

But if that's not how it plays out for you, seems like it could take a toll on the defense.
posted by ambient2 at 12:54 AM on August 26

a) About 14 months, I did extensive rehab before the surgery. In retrospect, I wish I had the the surgery about 7 months after my injury as that was the pinnacle of my rehab. You want to take as much strength and quad/ham/calf muscle mass into the surgery as you can. I would also lose as much weight as I could, 4 weeks on crutches post op put a lot of stress on my good knee.

b) I had an allograft 26 months ago. The upside is no harvesting of my hamstring or patella to recover from, the downside is the longer recovery period before the graft gains full tensile strength.

Clinically, each approach has its downside. The patella graft has patella healing issues, the hamstring graft is tricky to prepare correctly and may become lax, the allograft has knee stability issues.

It's easy to make the muscles around an allograft repaired knee incredibly strong, which will protect it from future injury (the hamstrings and gastrocenmius act syngeristically to the ACL). It's much harder to strengthen the knee that's had part of a tendon harvested along with an ACL repair.

c) The laproscopic incisions are going to drain down into your leg, causing ridiculous bruising and swelling that makes it impossible to stand for more than 5 minutes the first few days. Bromelain is your friend, seriously it works wonders.

The first few days, I would recommend keeping your lower leg and knee wrapped snugly with ace bandages when you walk around, it will help preventing additional swelling. Also, you will want a chair to sit in the shower, standing in the shower post op is terrifying.

Preparing food the first week is very difficult, delivery and people coming to make you food is essential.

NSAID's slow the healing of modeled ACL reconstruction in rats, avoid them.

Branch chain amino acids prevent muscle wasting, which is why they are used in burn patients. If you can afford them, 0.3 grams per kg of mass seems to work wonders. Otherwise, whey protein is an affordable way to prevent the muscle wasting that will happen in your injured leg as you lie around. The amount of muscle mass you loose in your injured leg directly influences how much rehab you will need to perform.

d) I sat around high as a kite on percoset for 3-4 days before I realized the pain was not bad, particularly if I used the continous-passive-motion (CPM) machine throughout the day, and while I slept. Sitting at a desk in the first two weeks will be difficult, as any time you spend with your knee below your heart will increase the already considerable swelling, and cause a fair amount of throbbing pain.

As far as the meniscus, triple threat injuries (ACL/MCL/meniscus) are associated with medial meniscus tears which are usually on the edge and repairable. There are two types of repairs, internal and external, with internal being preferred as the incision required for the external repair usually creates significant scar tissue on the joint capsule which can cause discomfort during the first six to eight months.

Something else to note, traditional single bundle ACL repairs do not aim to restore all pre-injury ACL function. The normal ACL has an anterior and posterior bundle, which allows the ACL not only to resist anterior translation of the tibia relative to the femur, but to control rotation of the knee, and resist varus and valgus stresses. Dr. Freddie H. Fu was pioneering double bundle repairs at U Pittsburgh a few years ago, preliminary evidence suggested this type of repair has increased rotational stability.
posted by zentrification at 1:20 AM on August 26

I had the same injury as you 12 years ago. The doctor used the hamstring replacement on me. The tear on my meniscus was minor and my issue was it was folded over.
Some things I recall. After surgery I was on a machine that flexed the leg. This was painful (but they gave me meds) but pretty beneficial as it helped prevent scar tissue from building up. Also, when the sent me home, they gave me this combo ice cooler/knee brace thing to help keep the swelling down. Cold water would flow into the knee brace from the cooler. Using that helped keep the swelling down.
As for the recovery in general. For years after the injury I could only manage to bend my affected leg to about 145 degrees (good enough for most things). However, a couple years ago I started martial arts and with some patience that legs now bends almost completely 180 degrees.
As for the hamstring graft, I really can't complain at all. I don't know how it measures up against the other types, but I have full confidence in my knee.
posted by forforf at 4:32 AM on August 26

Male, 24yo at time of ACL rupture. No meniscus damage. Don't know what particular surgery was done.

Have had very little trouble post-op. Did no PT (my surgeon, who was used by early all the pro-footballers in Melbourne, Australia at the time, said that if recovery time was not an issue - and I'm not a pro-athlete - then regular bike riding and/or swimming would be every bit as good).

(a) Initially decided not to have surgery after partial tear of ACL. 6 months later ruptured it playing soccer, and had surgery perhaps a month later.

(b) No idea. Still subconsciously favour 'good' leg, but other than a few scares when crashing when skiing moguls in the first few years it's been fine. No pain of any description at any time after first few years, and even then after the first few months only felt pain when I twisted it whilst pushing my limits. I don't do big jumps anymore, but I can still ski zipperline down pretty much any mogul field.

(c) I was fine. I took it slow and was very happy not to have to do PT. I'm an outdoorsy type and gyms hold no interest for me.

(d) I can't remember. My then new girlfriend was very helpful, and I was in no great rush to do anything but enjoy my new relationship. I do remember getting frustrated with how long it took to be able to bend my knee sufficiently to ride a bicycle - the first few rides were pretty hairy as I never knew when my leg would simply refuse - unannounced - to bend sufficiently at the top of the pedal stroke.
posted by puffmoike at 6:12 AM on August 26

Thank you for sharing your experiences! Keep 'em coming if there are more ACL surgery askmefites out there-- the more I know, the better I feel about it.

I had a surgical consult this morning, and they have tentatively scheduled me for surgery September 21st (almost 2 months post injury). They want to do it sooner rather than later because I could be aggravating the meniscus tear and just making it worse. I am very very nervous.

I seem to be getting the take home message that DOING THE PT is very very important. My therapist is good, and it also helps that he's pretty cute. I'm sure that will help when I'm in so much pain I want to punch him in his cute face.

As for the graft selection, it seems like the choice really depends on the disadvantages you would rather face, rather than the relatively similar advantages.
posted by hybridvigor at 7:44 AM on August 26

Oh! Also! I hear that the allograft (cadaver donor) is much more expensive than the tendon autografts. Do you know how much? My insurance pays 90%, but that 10% can still be a big wad of cash.

I guess I like the option with the cadaver donor of not injuring myself somewhere else to fix the ACL, and adding to healing time. But, what if I get a donor ligament from a murderer and then my knee starts kicking people in the crotch compulsively and I can't control it??
posted by hybridvigor at 7:56 AM on August 26

2 months post injury is a poor time to have surgery, your bone bruise has yet to heal, you didn't mention if you had regained full flexion and extention of the knee, or if you can perform a full squat, both of which are the gold standard for ACL repair pre-op physical therapy.

The allograft is more expensive as it needs to be purchased from a tissue harvesting service, but the operation is shorter and requires less OR time, which reduces costs. The allograft is usually a tibialias anterior tendon, if that is not available they shave down an achillies tendon.
posted by zentrification at 9:58 AM on August 26

@zentrification

I have full extension and 98 degrees flexion at this point. My surgeon has me scheduled for a check-up one week before the scheduled surgery to see if I have enough flexion for the repair. He said he needs 120 degrees for best post op results. I doubt I will be able to do a full squat for several more months.

My 2nd opinion surgeon was also supportive of surgery this soon, as long as I have the 120 degrees of flexion.

Are you a orthopedist or a physical therapist? Do you know something they don't? Thanks for the advice.
posted by hybridvigor at 10:06 AM on August 26

I'm just a guy who blew out his knee, borrowed his friends login from harvard, spent 12 months reading orthopaedic journal articles on ACL/menisus repair and rehab, and saw the top knee specialists at NEMC, MGH, NEBH and Beth Israel.

It's no surprise you've visited two surgeons who will operate with 120 degrees of flexion, it's an acceptable clinical guideline. Full recovery of range of motion, strength and muscle mass results in better outcomes.

It's the difference between receiving average care and doing everything you can to receive the best repair possible, accelerating your recovery and preventing reinjury. Full pre-op recovery, minimization of post-op muscle wasting (supplemental protein to maintain nitrogen balance), recovery of post op range of motion and muscle strength mass (particularly the gastrocnemius, medial hamstrings and VMO), modification of diet to handle the stress of surgery and assist in rehabilitation (long chain omega-3 fatty acids, EPA and DHA improve surgical outcomes across the board, regular physical exercise elevates protein requirements to 1.2 to 1.8 grams of protein per kilo of bodyweight).
posted by zentrification at 1:35 PM on August 26

(a) how long was it between your injury and your surgery? did you do PT before the surgery? in retrospect, do you wish you had gotten the surgery sooner or later?

2.5 years between injury and surgery. Did PT before the surgery, and after. I decided to see how I managed without an ACL, and eventually decided that restricting myself to running, swimming, biking, and other no-ACL-friendly sports was not sufficient and got it. I guess I could have gotten it earlier, but I'm kind of glad I learned to get along without it. Although learning to compensate for it did mess me up a little (muscle imbalance) so I'd say I probably would have gotten it done earlier, maybe around the 1 year mark.

(b) what type of graft did you choose (allograft, patellar tendon or hamstring)? how long has it been since your surgery, and what advantages and disadvantages have you found related to your specific graft choice? Hamstring/patellar pain, etc?

Hamstring graft. At the time I was told that it would disrupt my health the least overall - patellar tendon graft can be quite painful in the area where it's removed, but of course you will know that since you've been googling. It's hard to say advantages and disadvantages unless you've had both types and can compare. No patellar pain, obviously. Hamstring pain was bad for first few weeks, but mostly gone by the end of month 1. I ran a 10K at 100 days post-op, so the recovery to semi-normalcy was quite quick.

(c) post-surgery, what do you wish someone had told you?

* Do the PT!!! Continue it even after you feel like everything's back to normal. It's hard to motivate yourself when you think everything's fine, but don't stop until the PT tells you it will be fine. You should probably keep it up for a year or two after you stop PT in some form or other.
* It's not as scary as it seems...
* Do not expect to be able to do everything you could do before to the same extent. I know at least 5 other people who've blown ACLs, and some of them just assumed that once it is fixed, it will be just like before. It's not. There's some loss of proprioception, and it's never quite going to feel the same. One of them went back to soccer and played all-out as before and had blown it again within six months of returning to the sport. You need to accept that this injury is with you for life.

(d) post-surgery, how long were you useless? (I have a job in which I can sit on my butt all day at a computer, but if I'm in a lot of pain, I will still be mentally useless and unable to do it.)

I'd say I was totally useless for about a week, mostly useless for another week and a half. I went out on the bus to dinner after about 2.5 weeks and it was mostly ok, although extremely painful to sit down. After three weeks I went back to work, and that was fine; I kept my leg up on the desk for another week or two. At about 100 days I ran a 10K (slowly), expecting to have to stop after a K or two, but it didn't bother me at all.
posted by bone machine at 2:02 PM on August 26

In case anyone checks this thread again, I actually met my dream-ACL interview subject at PT the other day, who had received all the types of graft.

She had received ACL surgery FOUR TIMES on both of her knees-- one hamstring autograft, one patellar autograft, and 2 allografts, the most recent of which she was recovering from at the time. This girl was on the varsity lacrosse team at my university-- note to self: never play lacrosse.

She said she was overall much happier with the allograft results- that several years after surgery it felt stronger and the recovery process was less painful and better. She had a horrible time with a patellar autograft that gave her a lot of pain and ended up not incorporating into her bone and ultimately failing. I know it's a very specific instance, but I'm leaning towards the allograft.

Thanks again for all your input!
posted by hybridvigor at 10:24 AM on August 29