Primer on ACL Surgery

[docrugby1]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

 

[d'son d]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries are likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

nice summary, doc. education comes in different venues. As a non-orhopod it's always good to have other venues explained so the reality of the issue can be seen. Because of the prolonged recovery and rehab (and there have been some athletes returning to full activity within the year) it presents an interesting situation. What happens if there is a QB who steps up and plays well for us, having been given a chance to play "early", and secures his spot.What happens to CT when he is ready to play again?

 

[Hungry Jack]

Translation: the ACL stabilizes your knee, especially during sports. If it is torn, you are basically screwed until you get it fixed. The surgeons can create a new ACL from part of your hamstring, your patella tendon, or from one taken from a dead guy.

 

[SciCat]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

What about the new B.E.A.R surgery? Is it available outside of clinical trials?

 

[docrugby1]

What about the new B.E.A.R surgery? Is it available outside of clinical trials?

I have no experience with the BEAR ACL technique-it is years away from being available

The technique uses a "sponge" to bridge the gap in a torn ACL. The patient's cells use the sponge as a scaffolding to repair the ligament

Only time will tell if this is a viable form of treatment

 

[hdhntr1]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

When I had mine done, it was Patella Tendon. But I did not know bone was also harvested. Of course it was over 20 years ago.

 

[stpaulcat]

Translation: the ACL stabilizes your knee, especially during sports. If it is torn, you are basically screwed until you get it fixed. The surgeons can create a new ACL from part of your hamstring, your patella tendon, or from one taken from a dead guy.

Would the dead guy have to get credit for touchdown passes also?

 

[hdhntr1]

Would the dead guy have to get credit for touchdown passes also?

Does his estate get part of the pro contract?

 

[stpaulcat]

When I had mine done, it was Patella Tendon. But I did not know bone was also harvested. Of course it was over 20 years ago.

Did you recover completely and what was the timeline?

 

[Alan Smithee]

Translation: the ACL stabilizes your knee, especially during sports. If it is torn, you are basically screwed until you get it fixed. The surgeons can create a new ACL from part of your hamstring, your patella tendon, or from one taken from a dead guy.

It couldn't be from a dead chick? Asking for a friend.

 

[stpaulcat]

It couldn't be from a dead chick? Asking for a friend.

Did she play football?

 

[TheC]

Did you recover completely and what was the timeline?

Well... we know he never threw a TD pass for NU afterwards, so that is concerning.

 

[Hungry Jack]

It couldn't be from a dead chick? Asking for a friend.

Dead guys complain less about having their knees all scarred up.

 

[Purple Pile Driver]

Dead guys complain less.about having their knees all scarred up.

That’s the only thing I understood in this entire thread.

 

[mikewebb68]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

This is why I love it here! You just don't see this type of content on the Io_a boards.....

 

[Frabjous]

Translation: the ACL stabilizes your knee, especially during sports. If it is torn, you are basically screwed until you get it fixed. The surgeons can create a new ACL from part of your hamstring, your patella tendon, or from one taken from a dead guy.

But does the dead guy qualify as an NU student, both before and after he is dead?

 

[Deeringfish]

The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete

Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear

There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"

The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.

Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition

This should only be construed as general information and should not be considered related to CT's injury

THANKS DOC.
That was really good! Go Cats!!!

 

[hdhntr1]

Did you recover completely and what was the timeline?

Depends on what you mean by recovery. I was not trying to play high level sports. I never went back to some activities that I did before the injury like running or Volleyball. They took out 40% of the cartillege (Sp) as it was too badly mangled as it had been 7 years since the original injury ( The top ortho at in the area (Springfield IL and he may have been still opening up the knee) at the time said I was old so just rehab and live with it but it was unstable and kept going out. One of those times led to the surgery (arthoscopic) After the surgery I got range of motion back as quick as I could and worked had on getting the knee back in shape. Because of how much cartillege was removed, I never went back to running or sports other than individual workouts. I could do most of what I wanted in 6 months or so but again, I was not trying to be a high level athlete and never went back to some activities. For the most part, everything has been fine but even now I do notice it on occasion . I have been lucky because I have not had to deal with additional surgeries that others with that background have had to.

 

[hdhntr1]

Well... we know he never threw a TD pass for NU afterwards, so that is concerning.

Of course I never threw one before either

 

[AlliCat_is_back]

It couldn't be from a dead chick? Asking for a friend.

I've had my ACL replaced, with my own hamstring tissue. The surgeon that did my surgery said he had put a 16 year old girl's ACL into Carson Palmer.

FYI I was 28 when I did mine and within 4 months I was running and playing light sports. After 6 months I felt completely comfortable testing my knee playing basketball... Of course, I was not playing full contact football against world-class, 300-lb athletes. I don't think I'd ever feel comfortable doing that

Here's an article on Carson Palmer's two ACL tears - the first is the surgery my surgeon had just completed, in 2006.

http://www.espn.com/blog/arizona-ca...et-recovery-rehab-eight-years-after-first-acl