Walt's ACL Surgery

by Walt
(San Diego, CA)

I am having the surgery next week (Aug 6, 2008) and I have to make a graft choice. I am 42 years old but very active. I still play baseball, softball, basketball and golf, so I am having a hard time deciding what graft will be best for me.

I initially put down allograft but now I am leaning more towards autograft, but am mixed between the the patella and the hamstring.

I would like to return to regular sports activity as soon as possible which points me in the direction of using the patella and I will deal with post-op pain, but I am concerned about the potential future problems such as fractured knee cap, patella rupture and chronic anterior knee pain. A lot of the research I have found on-line seems to be old.

I know fixation has been a concern with use of the hamstring tendon. Are there new fixation devices that decrease the amount of rehab and close the gap to using the patella tendon and returning to action?

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Walt's ACL Surgery

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Aug 01, 2008
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Graft Choice NEW
by: Anonymous

Bart- Thank you very much for your input. I did decide the other day to go with the patellar tendon graft after speaking with some people and having a long discussion with a friend who has had both done and works in the industry. I orginally asked him his advice and he initially told me to research it and them we can discuss it. I did and we did. At the end of our discussion I asked him which one does he think I should go with and he said he would go with the one my doctor recommends.

Thanks for the feeback and I will keep you updated on any further questions and my postop.

Aug 01, 2008
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Hope this isn't too late... NEW
by: Bart - SII

Hi Walt - sorry to take a day or two to answer your question...

When it comes to graft choices, there are lots of things to consider. Every graft has both benefits and drawbacks, and it sounds like you have done some research and found this for yourself. In my opinion, I think that a patellar tendon allograft would be a good choice for you...let me tell you why.

From my clinical experiences, I have found that allograft patients tend to have much less post-operative pain, swelling, strength, and motion loss - this doesn't effect the overall recovery time, but it makes the early stages much easier and more bearable. I recommend to the majority of my patients over the age of 40 to consider it. While 40 is in no way old, the body does heal slower and it takes a little more to recover.

I have had pateller tendon allograft ACL patients as young as 23, and they were very active and did quite well.

When it comes to graft choices, I believe that fixation is the number one consideration - if the graft doesn't have a solid attachment to the femur and tibia, it will migrate over time - whether this produces frank instability, or simply a little bit of extra motion, the vast majority of 5 or 10 year problems I have seen have been with hamstring grafts...

Now, with that said, the skill of the surgeon does play a role - but the idea of the patellar tendon graft that will utilize the bone plugs to heal into the tunnels is perfect for solid fixation. The primary drawback, as you mentioned is post-op pain and anterior knee pain - with the allograft option this is virtually eliminated because you don't disrupt your own patellar tendon.

If it was my knee, I would chose the patellar tendon allograft - and I am active and 31 years old.

Hope this helps - please comment back if you have other questions - and good luck with the surgery - let us know what you choose and how things go (and you can post pictures too!)

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