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  1. #1
    rollin
    Reputation: sriracha's Avatar
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    busted tibia, shredded ACL...insight

    recently, i broke the top of my tibia and completely shredded my ACL in a freak dirtjumping incident.
    i'm on my third week of recovery. i had surgery on the tibia, where the doc re-attached the bone with two stainless steel screws.
    when that heals, i need to get surgury on my ACL.
    i don't know if i'll have patella or hamstring replacement...i see the doc in 3 weeks to discuss. any recommendations?
    and more importantly, what will my ACL recovery process be like? will i start walking right away? or continue to be on crutches.
    and the ultimate question: how long after ACL until i'm back on a bike? road bike? XC bike? DH bike?
    any rehab advice?
    thanks, in advance, for any insight.

  2. #2
    dru
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    acl

    Don't worry acl replacement works well, although it hurts like hell. My replacement is 16 yrs old. You will be riding almost right away, but you'ld better keep it mellow for a 1 year minimum. The gold standard is what I had done-the graft comes from the centre 3rd of your patellar tendon. The other procedure takes its graft from the hamstring. I know people who have had this one, it works fine too.

    As for post op, I'll tell you straight up it hurts-although I'm probably just a *****! Some docs have you in a device that flexes your leg every minute or so, others like mine prefer to immobilize the leg for a few weeks. I was quite naughty and started riding again about two weeks after surgery. I ditched the crutches early too; I think I was supposed to be on them about 6 weeks. Your injured leg will lose muscle mass that you will have a very hard time regaining. My right quad is an inch and a half smaller in circumfernce than the left. A lot of pain will radiate from the kneecap area because live flesh was cut for the graft. Every time, and I mean every time you use your quad expect agony from your knee for the first few weeks. Mind you your leg is already busted up, so surgery probably won't be any worse than what you've already experienced.

    Your acl, even after a year will only get to about 80% strength, and won't get better. You can definitely f$%& it up again.

    Mind you, luck has a part to play. After my surgery I got a black belt in karate, then boxed for several years at university. Needless to say, I bike a lot too, and have had zero problems with my knee aside from the cartilage wearing out.

    You can easily die from infection, so follow your doctor's advice completely as to health care and antibiotics. My only worry about the surgery is this risk. As I said, mine is 16 yrs old, and hospitals were a lot cleaner then.

    Drew

  3. #3
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    Acl

    Sorry to hear about your accident.
    As far as the Auto vs Allograft and HS vs Patellar Tendon there are a few small things to consider, in my opinion, there is not one that is head and shoulders above the other. Rehab is only slightly differnt.
    As far as rehab, it is quite possible that if your Tibial Plateau Fx (I presume), remains non weight bearing, you may still continue to be non weight bearing until it is healed regardless of what is going on with the ACL.
    Some docs are more aggressive than others. If your Tib is healed, I believe that the pt should be walking ASAP after the ACLR.
    You should be able to lightly spin on the bike nearly immediately after your reconstruction. As far as on the bike outside, you are probably looking at 12 weeks at the soonest. Competitively riding may be 6 -12 months if no complications.
    BoiseBoy

  4. #4
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    Reputation: sriracha's Avatar
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    thanks for the insight.
    yah, i split my tibia plateau in half, pushed the chunk down 8mm and back 8mm. the doc moved it back up and into place, then screwed 'er down.
    i was told: "no weight bearing for 3 months" on the tibia.
    i hope i can get ACL surgury after 6 weeks and focus on non weight bearing excersises and stretches. we'll see i guess.
    i talked to a skiing friend who has the patella acl on the left and the hamstring acl on the right. according to him, the hamstring replacement is a lot less painful...only painful for about 2 days. regardless, he said, it will be nothing compaired to the pain i allready went thru.

    that's good for me to hear that i'll start rehab very soon after the ACL surgury. cuz, right now, it seems like i'll never get off these crutches. i went for a 4 block walk on my crutches today and it took a lot of effort.

  5. #5
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    I feel your pain. I've been on crutches for 2 months now, with a tibial plateau fracture. I just got cleared to start putting some weight on it, so I'm on one crutch now. It sure makes it easier to carry stuff with one hand free. My fractures didn't require surgery so I was lucky there. My knee joint is intact but very stiff and swollen. I have lots of rehab ahead.

    It sounds like you're in worse shape than me. Good luck to you, man!

  6. #6
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    See my avatar, I feel you guys, do whatever the Doc says and you'll live to ride another day...

  7. #7
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    Have you considered donor tissue for the replacement? I had to get my knee fixed quick and I didn't want all the pain and separate injury sites. I had the surgery 3 1/2 years ago and no real problems yet. I ride motocross and I had to go through boot camp with the repaired knee too, none of any of that bothered it. I just did some more martial arts advancing and I was worried someone would kick me wrong and f^*# up my knee but still no problems and way less pain than having a harvest site to worry about.

  8. #8
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    I have had 2 ACL reconstructions(one on each leg) in the last 5 years. Most people have different opinions on grafts, but I after doing a lot of research I decided to go with the Patella tendon autograft. The patella tendon is attached with bone on each end of the graft so after 4 to 6 weeks the graft attachment is solid. Alot of research says that the graft is weak between 1.5 and 3 months while the graft is revascularizing(regaining circulation), but Dr. Shelbourne who is one of the leading Orthopedic surgeons in the US has did a study where he has taken biopsies from ACL patients at the 1 month post op mark and has found the tissue of the graft to be alive and well. A allograft(using donor tissue) patella tendon has bone to bone contact at each end as well, but when it is transplanted the tissue is dead, and it takes up to a year for it to revascularize. While it is undergoing this process the graft is really weak, and prone to stretching, or retearing. The hamstring graft itself is pretty strong, but the attachment technique requires attaching the soft tissue of the graft to the bone of the tunnels the graft is placed in which isnt as solid as the bone to bone attachment of the patella tendon graft, and can take up to a year for the bone to soft tissue attachment to become solid. I chose the patella graft because the sports I am interested in are all high contact (motocross and off road motorcycle racing and mountain biking) and the patella graft would get me back to my sport the quickest. In my current reconstruction I was walking normally within 2 weeks, and riding a stationary bike an hour a day everyday at week 4. At 2.5 months I had full strength back in my operated leg, and now at 3.5 months I dont even think about the leg any more, and I can start racing again at 6 months. I have been happy with both of my reconstructions, and havent had any issues with either one. Another important thing to ask your prospective surgeon is what attachment technique he uses, alot of surgeons uses bioabsorbable screws which can lead to some complications when the screw starts to dissolve. My doc used buttons at the mouth of the tunnels and attached the bone plugs of the graft to these buttons with sutures which holds the plugs in place until the bone plugs heal into the tunnels.

  9. #9
    In my mind, I can do it!
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    Quote Originally Posted by sriracha
    recently, i broke the top of my tibia and completely shredded my ACL in a freak dirtjumping incident.
    i'm on my third week of recovery. i had surgery on the tibia, where the doc re-attached the bone with two stainless steel screws.
    when that heals, i need to get surgury on my ACL.
    i don't know if i'll have patella or hamstring replacement...i see the doc in 3 weeks to discuss. any recommendations?
    and more importantly, what will my ACL recovery process be like? will i start walking right away? or continue to be on crutches.
    and the ultimate question: how long after ACL until i'm back on a bike? road bike? XC bike? DH bike?
    any rehab advice?
    thanks, in advance, for any insight.
    ACL replacement via the patella worked dang well for me. 5 and a half months after the surgery I was on the ski slopes skiing hard like always. There were some keys to the success though.

    1. Make sure you have a sports medicine doctor do the surgery.
    2. You HAVE to do the physical therapy.
    3. Go to a sports medicine clinic where even the physical therapists are geared toward athletes.

    My knee has been great for the past 13 years since the surgery. Except crawling on my knees bothers the heck out of me now. My patella will never be the same in that regard.

    Good luck!!

    Oh, BTW - It helps if your therapist is a babe and you try really hard to impress her with your progress.....

  10. #10
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    ACL surgery isnt always neccessary

    I tore my ACL, medial and lateral meniscus all in one crash last year. It hurt like hell but I delayed going to the Dr. I figured if I could ride a bike why see a Dr. I did two XC races and a major hill climb race with a bad knee. After the races I went to see an orthopedic surgeon. Four months after the injury I had the knee scoped. I had the medial and lateral meniscus cleaned up. After the surgery my Dr said I had a torn ACL but I should wait before any surgery. I had the knee scoped in December, by July all of the weakness in the knee had gone away. I can hike and pretty much go up and down stairs and carry and pick up heavy items.

    Right now I have no plans for ACL surgery. The only thing I can see it would help would be if I planned on running. I hadnt done any running before the surgery and I am not planning on doing any running now. I guess I am screwed if I have to outrun a tsunami, an avalance or the cops. There are lots of people with torn ACL's. The surgery itself is fairly new and wasnt done before the 70's. Everyone is different and my Dr. said that I had pretty strong knees and there wasnt any movement in the knee so he thought I should wait before doing any surgery.

  11. #11
    dru
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    Be careful then! I had, what can you say, an 'active' decade in my twenties (lots of stupidity), and can tell you that any sudden movement you make with side loading on your knee will put you on your butt quicker than you can blink. I dislocated my knee 5 times from 1st tearing my acl to getting it repaired. Of course everytime this happened I mangled the hell out of my meniscus.

    The dislocation list: 1 throwing roundhouse kicks, 2 doing boxing coordination drills, 3 running on ice, 4 riding a moto crosser, 5 karate.

    Ouch (of course it swelled up like a grapefruit every time and hurt for months afterward)

    The original injury happened in a drunken wrestling match with a buddy- SNAPPPP!

    Good thing I had drunk enough liquid pain killer!

    BTW, Doctors and nurses hate hungover idiots who have mangled themselves!

    ;-)

    Drew

  12. #12
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    Quote Originally Posted by borregokid
    I

    Right now I have no plans for ACL surgery. The only thing I can see it would help would be if I planned on running. I hadnt done any running before the surgery and I am not planning on doing any running now. I guess I am screwed if I have to outrun a tsunami, an avalance or the cops. There are lots of people with torn ACL's. The surgery itself is fairly new and wasnt done before the 70's.
    Get a second opinion. Always get a second opinion.

  13. #13
    rollin
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    thanks, everyone for your input. much appreciated.
    i just visited the doctor. 6 more weeks of non-weight bearing, and then i go in and get an ACL. good news is that i get to start rehab, work on getting my range of motion back and strengthening my muscles before the ACL oporation.
    we talked a little about ACL options, which align with most of the comments above.
    here's what the doc said:
    patella: strongest ACL replacement, the gold standard, fairly painful, but worth it in the long run, quick recovery - will give me the best ACL
    hamstring: least painful, quickest recovery, but weakest option, it tends to stretch easier.
    cadaver: no pain, fairly strong, but takes the longest for the body to adopt.

    i'm pretty sure that i'll just take the pain and go for the strongest ACL option, the patella.
    3 more months and i should be on a road bike.
    thanks again for all the comments, and please feel free to add more.

  14. #14
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    I had the patella graft done when I tore my ACL strained my LCL and MCL and fractured the side of my knee joint a few yrs back. Due to being in college at the time I had to wait till May to get the surgery done (I hurt myself in March) I used the time leading up to the surgery to get my knee and its surrounding muscles strong with PT 4 times a week. After my surgery even though it hurt incredibly I followed the doctors orders and did light excercises with my surgified leg. Basically at first all I could do was flex my calves and my quads to keep them from going into atrophy. 12 days after surgery I could make a full rotation on my bike trainer on the lowest resistance setting with the bike in a granny gear. This was more for range of movement rather than strength training. Then 3.5 weeks post op against doctors orders I hopped on the bike and did some road riding. I figured since I was pushing my leg pretty hard with my physical therapist on an eliptical trainer and a stationary bike a few miles here and there on the bike wouldnt hurt it as long as I was safe. I was prolly stupid to be doing this but luckily I didnt take any falls and I was right with my judgement (If you do this do so at your own risk). I got the OK oficially to bike from my doctor after about 2.5 months and 7 months later I was given a clean bill of health. The coolest part though was the neat pictures I got to take home from the surgery:
    The first pic shows my joint and the torn ACL stump.
    The second pic shows the Dr removing the debris from the old ACL and installing my patella graft with some screws.



    Then this is what my knee looked like 3 months after surgery:
    Hiking is just walking where its okay to pee... Sometimes old people go hiking by accident. -Demetri Martin-

  15. #15
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    Another item to consider is the Losee(???) procedure. I had it done during the second acl replacement on my right knee. The first time I had patellar, the second was hamstring. What the losee does is cuts a piece from the hamstring for the graft, then stretches the hamstring down and attatches it to the tibia, adding stability to the knee joint. This has held together with no problems for 10 years now(I was one of the experimental patients to first recieve the losee procedure).

  16. #16
    menace to myself & others
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    I had the hamstring version done a couple years ago. So far, so good! I chose that method because I have had generally bad knees, even before blowing out my ACL, and there is a substantially greater risk of patellar arthritis, or so I was told.

  17. #17
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    Nik, sorry to hear about your boo-boo meng.
    I feel your pain brotha. Although I've been cleared to ride, the arm is still a crooked mess but getting better.

    I'm just starting to attempt small hucks again cuz the impacts are kinda painful.

    Rehab is frustrating and painful, but you have to hang in there and keep going. Persistence and patience are key.

    If you give up on it............you're fuct.

    Take your meds and compliment them with the occasional herbal and liquid elixirs.
    Healing vibes to you my brotha!
    "Korash your enemiez, zee zem driven bevore you, and ear ze lamentation of za vemen"

  18. #18
    rollin
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    Quote Originally Posted by eo
    Nik, sorry to hear about your boo-boo meng.
    I feel your pain brotha. Although I've been cleared to ride, the arm is still a crooked mess but getting better.

    I'm just starting to attempt small hucks again cuz the impacts are kinda painful.

    Rehab is frustrating and painful, but you have to hang in there and keep going. Persistence and patience are key.

    If you give up on it............you're fuct.

    Take your meds and compliment them with the occasional herbal and liquid elixirs.
    Healing vibes to you my brotha!
    thanks eric. thanks for the words of wisdom and encouragement.
    when i saw pics of you back on your bike, i thought, wow, that was quick. 6 weeks and he's back on the bike. i had no idea you were still working on it. healing vibes back at you.
    i've been keeping up on the physical therapy. each week, i notice improvements. i'm at 0degrees to 100degrees in range of motion. i go see the doc today, hopefully he'll tell me to get off these crutches and start walking...i made myself a b!tchin cane this weekend, can't wait to use it. i'm gonna learn some sweet ninja/samari moves with it...drunken cane!
    it starts all over again, when i get surgery on my ACL, tho.

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