# ACL Reconstruction after 50... allo or auto graft?



## ron m. (Aug 1, 2009)

I ruptured my ACL last month playing pickup basketball. My ACL reconstruction is scheduled next month. My doctor said he can do an allograft or an autograft (patellar or hamstring). I am 54 years old, weigh 150 lbs and ride pretty aggressively (like mid-sized jumps and drops). I would like to hear people who've had the procedure after 50 and why you decided to go either or (allo vs auto) and if you decided auto, where did you harvest the tendon? SO MANY CHOICES! Lol!


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## OldMike (Apr 30, 2020)

I'm surprised the Dr offered surgery. I blew my ACL out in my late 20's and after a recent spill i went back to the Dr's for a check up and found out the reconstruction didn't last (most likely blew it out playing hockey yrs ago).
Anyhow the same Dr that performed the first ACL reconstruction advised against it, saying that pulling the knee closer together would be far worse for pain and recovery for someone my age then not having it done at all. I was 50 at the time.


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## sherwin24 (Jul 23, 2010)

I had an autograft in my 20's that took quite a while to fully heal from where they took the patellar tendon. At 45 I had the other knee done and my dr. suggested allograft due to my body already being 45, hence the ligaments and tendons are 45 years old. Allograft he could get a younger specimen to hopefully last longer. Recovery was much better with the allo and working fine 6 years later.


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## sherwin24 (Jul 23, 2010)

I would add, that riding a bike probably helped the recovery more than anything else. Once I was cleared to do easy rides, things moved along to where at 6 months I was riding trails with a brace on and was able to ride tech and everything short of drops just fine. I think at 6 weeks or 2 months maybe, they cleared me to ride bike, but just rail trail type stuff, which helped progress quickly.


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## Brian HCM#1 (Jan 18, 2004)

Had the patellar in my right knee when I was 34 and hamstring in the left when I was 47. Patellar recovery was way more painful than the hamstring, however I was told the patellar is the strongest of all the reconstruction procedures to get you back to the level you were once at. I take it easy, still ride DH and play softball 3-4 nights a week. I just have taken it down a notch as I'm getting old and every part of my body aches.


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## ron m. (Aug 1, 2009)

Ha! Thanks for the replies so far. I do appreciate each one and will seriously take everything into consideration. I took my gimpy ass out for a ride today for the first time since my injury (wore a Donjoy brace) and aside from an occasional clicking, my riding was close to normal (well, I took the cheater bike today so that helps). But for sure, I don't think I can ride full send (to me) unless I'm totally fixed, and I want to make the best decision for me.

I could sense that my doctor prefers that i choose the allograft... but I've read far more negative feedback from that procedure (even taking away the fact that they don't irradiate the tissue anymore) than an autograft. But then maybe things have changed lately.


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## epittman (Apr 4, 2021)

Take a good look at the long-term outcomes for these types of ACL repairs. I recall reading that a large portion of them don't hold up in the long term and often physiotherapy for joint stabilization is a pretty good solution.

The surgeon should have the stats on that stuff for you to help make the decision.


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## Mike Aswell (Sep 1, 2009)

Cadaver is non weight bearing for a while which kinda stinks.
Patellar is more painful long term, IME.
Hamstring is less pain but for years I struggled to get my hamstring back to full strength.

I'm 42.
Right knee hamstring @ 19.
Left knee patellar @ 36.

I wouldn't highly recommend one over the other but if you really like to get after it and want to recover quickest then patellar.


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## Brian HCM#1 (Jan 18, 2004)

ron m. said:


> Ha! Thanks for the replies so far. I do appreciate each one and will seriously take everything into consideration. I took my gimpy ass out for a ride today for the first time since my injury (wore a Donjoy brace) and aside from an occasional clicking, my riding was close to normal (well, I took the cheater bike today so that helps). But for sure, I don't think I can ride full send (to me) unless I'm totally fixed, and I want to make the best decision for me.
> 
> I could sense that my doctor prefers that i choose the allograft... but I've read far more negative feedback from that procedure (even taking away the fact that they don't irradiate the tissue anymore) than an autograft. But then maybe things have changed lately.


Allograft as a last resort IMO, they also have a higher failure rate than a patellar or hamstring. At 50, I'd go hammy!


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## stripes (Sep 6, 2016)

ron m. said:


> Ha! Thanks for the replies so far. I do appreciate each one and will seriously take everything into consideration. I took my gimpy ass out for a ride today for the first time since my injury (wore a Donjoy brace) and aside from an occasional clicking, my riding was close to normal (well, I took the cheater bike today so that helps). But for sure, I don't think I can ride full send (to me) unless I'm totally fixed, and I want to make the best decision for me.
> 
> I could sense that my doctor prefers that i choose the allograft... but I've read far more negative feedback from that procedure (even taking away the fact that they don't irradiate the tissue anymore) than an autograft. But then maybe things have changed lately.


I had an allograph done 10 years ago at 38. Donor Achilles tendon. The doctor who did mine isn’t found of autographs because now you’re healing from two injuries instead of one. 

Knee recovery was relatively easy, especially since i stayed on top of PT and pedaling constantly. If i had to have another ACL surgery, i would want the same type.

Knock on wood it’s still there in one piece. Did prehab, and still a lot of biking now. Yesterday i was doing this: 










You’ll learn how quickly you need to get your quad working again no matter which surgery you have. This is why pedaling is so important. It’s quad dominant.


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## beastmaster (Sep 19, 2012)

I tore my ACL and lateral meniscus (outside of the joint) on January 17th, 2019 in a stupid ski accident. I was just about to turn 56 at the time. I am 58 1/2 now.

The doctor repaired my ACL using my hamstring tendon (autograph is using your own body while allograph is using a cadaver's). There is a lot to having this technique done and don't know about the other approaches because I didn't get those done. First of all ligaments are like leather (not stretchy) while tendons are more like rubber bands. Ligaments hold bone to bone while tendons hold muscle to bone. They will use a metal screw in your tibia and a plastic one in your femur to hold the new ligament in place. The metal one requires drilling a whole through the joint to insert the new ligament through and set the fixation screw in place. The plastic one is attached on the surface of the backside of the femur. They will do this whole thing using arthroscopic surgery, will fill your knee joint with fluid and to say they man-handle your joint is totally an understatement. From that alone you will be in pain. Luckily, my meniscus tear was minimal and only need to weight on it. I was non-weight bearing for 8 weeks. That sucked. Weeks 8-12 were no fun with PT. Weeks 12-16 were more interesting, but still not fun. Weeks 16-24 were beginning to be fun. I was able to begin road riding by week 28 or so. I rode my MTB for the first time probably around month 3.5 or 4. All during this time I went to PT twice a week and the gym 5 days a week after work. I was riding hard uphill by the end of October but still very reserved when it got super techy. I was given to go ahead to ski at the beginning of ski season (end of November).

The first 8 weeks the newly installed tendon basically dies because when the old ligament is removed, the very limited blood supply is disrupted. The second 8 weeks is the transformation of the tendon into a ligament (it is called transmogrification). It takes about 16 total weeks for this phase and then another 8 weeks for the blood supply to become stable again to the new ligament. You have to be extremely diligent with your PT and the protocols. Follow them like your life depends upon it. Once you get the go ahead to begin working out, do it and follow your PT's recommendations. They know a lot about recovery and maybe more than your surgeon who knows the medical procedure but probably doesn't follow the end results as much, strange as that might sound.

You will feel way better and really want to begin pushing yourself at or around 16-18 weeks. Don't do it. It takes a solid 9 months for this recovery and you will still not be back to your old self at that point. So take it easy and play the long game. It took me about 18 to 24 months to have equal leg strength again. I worked really hard on all the gym exercises including a **** ton of proprioceptive stuff. Don't slack off with the gym stuff and let them really dig deep into you so you can regain maximum range of motion. Eventually you will be able to begin riding bikes. But be very careful with a locked knee-full extension leg out sudden stops as they will re-injure the knee. If you have to stop quickly, always make sure your knee is bent to absorb the impact. The other way causes sheer forces which you don't want.

I am now with a completely good new ACL and fully recovered from the meniscus tear. I can do everything I did before the injury without any concerns or pain whatsoever. I wore my ACL custom brace for the first year skiing. It was not recommended on the bike. I decided to not use the brace about 1/2 way through the second season of skiing and that is when I started to make really good strength gains. Both my PT and doc suggested not using it long term, but didn't have a particular idea of when that would be for me on the front side. I am not an unusual patient or exceptional in my outcome. I just did what they said to do and worked as hard as I could to get where I am now. Everyone is going to have a slightly different result. You just want to be in the range you were in before the injury and that is possible. Good luck!


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## ron m. (Aug 1, 2009)

beastmaster said:


> I tore my ACL and lateral meniscus (outside of the joint) on January 17th, 2019 in a stupid ski accident. I was just about to turn 56 at the time. I am 58 1/2 now.
> 
> The doctor repaired my ACL using my hamstring tendon (autograph is using your own body while allograph is using a cadaver's). There is a lot to having this technique done and don't know about the other approaches because I didn't get those done. First of all ligaments are like leather (not stretchy) while tendons are more like rubber bands. Ligaments hold bone to bone while tendons hold muscle to bone. They will use a metal screw in your tibia and a plastic one in your femur to hold the new ligament in place. The metal one requires drilling a whole through the joint to insert the new ligament through and set the fixation screw in place. The plastic one is attached on the surface of the backside of the femur. They will do this whole thing using arthroscopic surgery, will fill your knee joint with fluid and to say they man-handle your joint is totally an understatement. From that alone you will be in pain. Luckily, my meniscus tear was minimal and only need to weight on it. I was non-weight bearing for 8 weeks. That sucked. Weeks 8-12 were no fun with PT. Weeks 12-16 were more interesting, but still not fun. Weeks 16-24 were beginning to be fun. I was able to begin road riding by week 28 or so. I rode my MTB for the first time probably around month 3.5 or 4. All during this time I went to PT twice a week and the gym 5 days a week after work. I was riding hard uphill by the end of October but still very reserved when it got super techy. I was given to go ahead to ski at the beginning of ski season (end of November).
> 
> ...


Is there a reason you opted for hamstring over patellar tendon? Or is that more of a doctor recommendation?


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## In2falling (Jan 1, 2005)

Blew mine out in high school 1987 and waited 13 years (2000) to get a allograft (tibialis tendon) done by Phoenix Suns Ortho (Thomas Carter) one of the best. At the time he stated he was doing close to 200 of them a year. Think more important than graft type is making sure you have a good experienced orthopedic surgeon doing the surgery. Probably don't want some newbie inexperienced surgeon doing the work (they are not all created equally), so do your homework and shop around for a good surgeon.


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## beastmaster (Sep 19, 2012)

ron m. said:


> Is there a reason you opted for hamstring over patellar tendon? Or is that more of a doctor recommendation?


I don't recall exactly what my doctor's reasons were right now, but I know considerably more people who had their hamstring tendon harvested instead of their patellar tendon. The only people I know that have had the patellar tendon used were a lot young (teens or early 20's) when their injuries happened.


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## ron m. (Aug 1, 2009)

In2falling said:


> Blew mine out in high school 1987 and waited 13 years (2000) to get a allograft (tibialis tendon) done by Phoenix Suns Ortho (Thomas Carter) one of the best. At the time he stated he was doing close to 200 of them a year. Think more important than graft type is making sure you have a good experienced orthopedic surgeon doing the surgery. Probably don't want some newbie inexperienced surgeon doing the work (they are not all created equally), so do your homework and shop around for a good surgeon.


It's a Stanford doctor who specializes in ACL surgeries. His credentials include being the team physician for the Niners and Giants so I "hope" I'm in good hands?


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## ron m. (Aug 1, 2009)

beastmaster said:


> I don't recall exactly what my doctor's reasons were right now, but I know considerably more people who had their hamstring tendon harvested instead of their patellar tendon. The only people I know that have had the patellar tendon used were a lot young (teens or early 20's) when their injuries happened.


Thanks man. I know the patellar graft is the "gold standard" but I'm concerned about long-term knee pain, especially since our sport involves constant leg motion. Also concerned about having less structure on the knee cap because, well, I crash a lot. LOL


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## Mike Aswell (Sep 1, 2009)

ron m. said:


> Thanks man. I know the patellar graft is the "gold standard" but I'm concerned about long-term knee pain, especially since our sport involves constant leg motion. Also concerned about having less structure on the knee cap because, well, I crash a lot. LOL


In my original post I was very vague. The majority of knee pain I deal with in the knee I had done with patellar is from stuff like trying to kneel down on my knee cap. Just day to day life and even pedaling on a bike, there is no notable difference compared to my right knee (hamstring repair).

The pain/discomfort really does come from the fact that a rectangle is missing from your knee cap.

The good news is that I feel like largely you can adapt to this. For example, I try not to kneel on my left knee unless I have to. I know that sounds kind of overly simple but it's true.


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## beastmaster (Sep 19, 2012)

One thing I wonder about is whether the harvesting of the patellar tendon requires two larger entry points, one being somewhat larger to remove the tendon, as opposed to the two smaller entry points for the hamstring. I had 3 total points of entry--one for the scope/tools/where the hamstring is harvested, one for the fluid infusion, and one on the inside front of the tibial plateau where the metal screw was placed inside the bone to hold the new tendon. Seems like these techniques change fairly frequently as well, so who knows!

I cannot express strongly enough how important following your PT program is no matter which surgery technique you have. All of these require a good long rehab for full recovery. You will feel like going for it way earlier than you should go for it. Take your time with the healing and you will most likely (high 90 percentage?) have an excellent result.

The worst aspect of my accident wasn't the knee injury. I also got a good concussion. That really sucked. It took almost as long for me to get back to normal, clear thinking (whatever that means! Haha!) as it took for my knee to heal up enough to commence normal activities.

It did take at least 12 months past this point for full and equal leg strength to come back, so there will remain a fairly significant probability of re-injury due to leg strength imbalance. Do your proprioceptive PT workouts too. These are boring as all hell but well worth the time and effort.

Lastly, use a surgeon who worked on your friends who had good results. Don't over think this whole thing. It is a very common procedure.


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## 2strokenut (May 24, 2016)

ron m. said:


> I ruptured my ACL last month playing pickup basketball. My ACL reconstruction is scheduled next month. My doctor said he can do an allograft or an autograft (patellar or hamstring). I am 54 years old, weigh 150 lbs and ride pretty aggressively (like mid-sized jumps and drops). I would like to hear people who've had the procedure after 50 and why you decided to go either or (allo vs auto) and if you decided auto, where did you harvest the tendon? SO MANY CHOICES! Lol!


Allografts are sedentary people, not for active folks. If your Dr does not understand this then you need to find another more competent dr. The gold standard is Patella Autograft from opposite knee. Avoid the hamstring.

Source: Have had multiple acl surgerys and read the literature on it.


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## 2strokenut (May 24, 2016)

Also, as far as pain goes, I just had the Patella graft on my right knee in Jan of 21. Previously I had both acls done with hamstring 10 years ago. I was back to riding moto and Mtn biking in 3 months with the patella. Hamstring was much more painful and lasted for about 3 years before I could do stuff without my hamstring feeling like it was pulled constantly.


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## ron m. (Aug 1, 2009)

2strokenut said:


> Allografts are sedentary people, not for active folks. If your Dr does not understand this then you need to find another more competent dr. The gold standard is Patella Autograft from opposite knee. Avoid the hamstring.
> 
> Source: Have had multiple acl surgerys and read the literature on it.


Why the opposite knee? Wouldn't that mean that both my legs will be out during recovery?


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## 2strokenut (May 24, 2016)

ron m. said:


> Why the opposite knee? Wouldn't that mean that both my legs will be out during recovery?


It divides the healing time. If you pull the graft from the bad knee it then has to recover the new acl and where the graft was taken. So by taking the graft from the opposite knee you actually recover fully faster. It seems weird but that is exactly what I experienced. Both knees hurt for a bit but like I said before I was mtn biking 3 months from surgery, back to racing dirt bikes by 4.5 months.


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## In2falling (Jan 1, 2005)

2strokenut said:


> Allografts are sedentary people, not for active folks. If your Dr does not understand this then you need to find another more competent dr. The gold standard is Patella Autograft from opposite knee. Avoid the hamstring.
> 
> Source: Have had multiple acl surgerys and read the literature on it.


I have been super active (mountain biking/running/lifting/hiking) for 22 years with my allograft (tibialis tendon) and at this point think it will last the rest of my life.


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## ron m. (Aug 1, 2009)

Hey, thanks again for all the feedback. I'm sure all of you have done your research and chose the most appropriate application for you. From what I've read/listened to so far, the patellar graft remains the most effective and not necessarily because it's stronger, but because the Bone-Tendon-Bone interface allows for faster anchor integration (the bone interfaces fuse faster versus soft tissue on bone). I've watched a few experts talk about that being the primary difference versus other grafts, and they emphasize that re-tear rates on the other grafts are probably higher because they haven't anchored to the bone as quickly as a patellar graft. 

So on the surface, the patellar graft offers the fastest recovery period (wherein the tendon is fully anchored to the bone and minimized chance of re-tear) at the risk of negative outcomes associated with it (knee pain, neuropathy, arthritis, etc). 

The other options are tempting too (especially the allograft from an invasiveness standpoint) but I don't like the idea of scaling back for a year or two while my "aggressive window" is closing down quick. 

On the other hand, I might be overthinking this because I only care about going back to the same level of riding as I did prior to my injury, and will likely not engage seriously in sports that require a lot of slashing moves. To be clear, I am definitely NOT a pro or even a racer, but I do ride aggressively (in my mind of course) for my age. Having said that, does aggressive trail riding tax the ACL? I'll do moderate jumps and drops, but I ride full squish anyway.


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## 2strokenut (May 24, 2016)

In2falling said:


> I have been super active (mountain biking/running/lifting/hiking) for 22 years with my allograft (tibialis tendon) and at this point think it will last the rest of my life.


You got lucky. Failure rate for allograft in active adults in close to 40% last time I looked at the data. The allograft is iradiated and essentially dead tissue and the dr hopes your body can bring it "back to life" so that it doesn't fail. The dr also makes about 3k more for selling you someone elses tissue. The only advantage to an allograft is that you don't have to harvest the tissue from your own body so recovery is faster. This is great for older adults that are less active. An allograft has no place in an active adult, imo.


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## 2strokenut (May 24, 2016)

ron m. said:


> Hey, thanks again for all the feedback. I'm sure all of you have done your research and chose the most appropriate application for you. From what I've read/listened to so far, the patellar graft remains the most effective and not necessarily because it's stronger, but because the Bone-Tendon-Bone interface allows for faster anchor integration (the bone interfaces fuse faster versus soft tissue on bone). I've watched a few experts talk about that being the primary difference versus other grafts, and they emphasize that re-tear rates on the other grafts are probably higher because they haven't anchored to the bone as quickly as a patellar graft.
> 
> So on the surface, the patellar graft offers the fastest recovery period (wherein the tendon is fully anchored to the bone and minimized chance of re-tear) at the risk of negative outcomes associated with it (knee pain, neuropathy, arthritis, etc).
> 
> ...


The reason patella graft is the gold standard because of what you said, the bone interface. On a hamstring graft you are cutting a piece and folding it a few times to get strength and hoping the achor is good enough to hold. My hamtring grafts held for 10 years, left is still good and re-tore the right. Doc said the hamstring graft was done well, I just blew out my knee in the worst way possible and would have tore anything. Also important is that the patella tendon will grow back as if nothing was taken. A hamstring or other graft will be gone and never come back.

You don't want to be out for a year. I've watched moto buddies stop riding for a year, only to get back on the bike and re-tear it. Granted, moto is more taxing on the ACL than MTB but the risk is still there. Good luck


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## ron m. (Aug 1, 2009)

2strokenut said:


> The reason patella graft is the gold standard because of what you said, the bone interface. On a hamstring graft you are cutting a piece and folding it a few times to get strength and hoping the achor is good enough to hold. My hamtring grafts held for 10 years, left is still good and re-tore the right. Doc said the hamstring graft was done well, I just blew out my knee in the worst way possible and would have tore anything. Also important is that the patella tendon will grow back as if nothing was taken. A hamstring or other graft will be gone and never come back.
> 
> You don't want to be out for a year. I've watched moto buddies stop riding for a year, only to get back on the bike and re-tear it. Granted, moto is more taxing on the ACL than MTB but the risk is still there. Good luck





2strokenut said:


> You got lucky. Failure rate for allograft in active adults in close to 40% last time I looked at the data. The allograft is iradiated and essentially dead tissue and the dr hopes your body can bring it "back to life" so that it doesn't fail. The dr also makes about 3k more for selling you someone elses tissue. The only advantage to an allograft is that you don't have to harvest the tissue from your own body so recovery is faster. This is great for older adults that are less active. An allograft has no place in an active adult, imo.


Thanks, man! My doc told me that they don't irradiate the donor tendon anymore based on the research.


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## In2falling (Jan 1, 2005)

2strokenut said:


> You got lucky. Failure rate for allograft in active adults in close to 40% last time I looked at the data. The allograft is iradiated and essentially dead tissue and the dr hopes your body can bring it "back to life" so that it doesn't fail. The dr also makes about 3k more for selling you someone elses tissue. The only advantage to an allograft is that you don't have to harvest the tissue from your own body so recovery is faster. This is great for older adults that are less active. An allograft has no place in an active adult, imo.


"Published online 2019 Mar 14"
"Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective"








Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective


To assess the clinical and cost-effectiveness of allografts versus autografts in the reconstruction of anterior cruciate ligaments.Systematic review of comparative clinical effectiveness and cost-effectiveness analysis.Both autograft and allograft reconstruction ...




www.ncbi.nlm.nih.gov




"In ACL reconstruction, clinical results with autografts are as good as or slightly better than with allografts"
"There is little difference in results of ACL reconstruction with autografts or non-irradiated allografts"
Personally if I was 54 (which I am) and needed ACL reconstruction, I would do allograft. Don't like the idea of harvesting other parts especially the patella.
Just my opinion.


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## 2strokenut (May 24, 2016)

In2falling said:


> "Published online 2019 Mar 14"
> "Autograft or allograft for reconstruction of anterior cruciate ligament: a health economics perspective"
> 
> 
> ...



"personally, if it were me, I'd do the exact same thing I did"
I bet you would.


Published 2020








Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19 Years of Age and Younger: A Systematic Review and Meta-Analysis - PubMed


Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.




pubmed.ncbi.nlm.nih.gov





*Results: *The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. *Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69).
Conclusions: *Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients.

Also:









Effects of graft preconditioning on γ‑irradiated deep frozen tendon allografts used in anterior cruciate ligament reconstruction


Preconditioning of the grafts prior to implantation into the knee is considered to reduce the loss of tension caused by graft viscoelasticity after anterior cruciate ligament reconstruction. The present study analyzed the impacts of different preconditioning forces on the biomechanical...



www.spandidos-publications.com




*"All soft tissue implants, including ACL, undergo a similar incorporation process, including graft necrosis, cellular repopulation, revascularization and collagen remodeling (29). A previous study indicated that allografts were not as rapidly remodeled and incorporated into the host tissues as autografts"*

I'm just citing the data. You have risks with both, pain in the knee with autograft, and tissue rejection, longer non-weight bearing period and disease (if using non-irradated) allograft. Allograft whether its irradiated or not will require more non-weight bearing recovery. If you're ok with that, go for it. Not my knee. I know too many pissed off people who were sold on allograft and had a re-tear and then had to do an autograft anyway.


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## d365 (Jun 13, 2006)

I had the hamstring replacement when I was about 25. It worked out fine and has held up for 25 years. Where they took the hamstring was pretty tinder for awhile, but that was the docs recommendation. 

Attacking the PT afterwards is just as important. You really have to work at it to get back to 100%.


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## k2rider1964 (Apr 29, 2010)

I blew out my ACL in 2009 in a dirt bike incident when I also snapped my femur at my knee and also tore out my LCL, MCL and meniscus. I did the patella graft and pretty much resumed life 9 months later....mountain biking on even the gnarliest terrain (4-5 days a week), snowboarding and back on dirt bikes (stopped in 2012). The one thing I didn't resume was running due to the meniscus' being shot. There were two attempts to fix it but the repeated pounding is a non-starter. I hear they have artificial meniscus nowadays but my I'm happy with my active lifestyle as it is so I haven't looked into it.


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## ron m. (Aug 1, 2009)

*Well, I did it. *

I figured I'll just keep this thread as a journal of my recovery experience so others can have a point of reference (will edit as I continue my recovery). _* Disclaimer:*_ from the numerous people that I've talked to and the tons of videos I've watched, everyone's experience with this procedure (no matter how much alike they are) are never the same. The one common thing I do hear is that no one had any regrets, despite the long recovery. FWIW, the surgeon not only performed the *ACL reconstruction*, he also had to fix/trim damage incurred by the* medial* and *anterior meniscus*. I will NEVER play basketball again, EVER. LOL!

*Surgery Day:*
Went to the hospital in the morning. Walked in with someone who had the identical procedure a month prior (patellar autograft). He warned me of sleepless nights the first couple of days post-surgery. _ Spoiler alert: I had very little pain, slept TOO much and was off Norco within 24 hours. _ Went through normal check-in, waited a couple of hours for the procedure, was under general anesthesia at 10AM, woke up at 1PM and on my way back home at 2 PM. I slept for most of the evening, very likely due to the nerve block doing its job.

*Day 2:*
Didn't really feel any pain except when moving (and probably a 3-5 on the scale) so I decided to scale back from Norco to Motrin mid-day.

*Day 3: *
Hospital visit. I was moving more comfortably on crutches. The physician's assistant removed some dressing and inspected my leg, gave some tips for the next week and sent me on (again, having talked to several people and watching recovery videos, there always seems to be variations in the recovery approach. In my case, I need to continue keeping my leg straight until the sutures come off and THEN begin PT).

*Day 4-6:*
Been walking on crutches every day. Starting to put a bit more weight on the affected leg but probably less than 50%. Got the technique of going up and down stairs pretty good. Pain continues to be minimal although there would be times where it would throb at the harvest area but it goes away in a few minutes. No pain medication since day 3.

I continue to hope that recovery and therapy continue to be manageable and successful.

*Day 17*
Just went to the doctor. Stitches were finally removed. Also allowed to bend knee as much as I can tolerate. Was strongly encouraged not to push it until I meet with the PT. Am able to bend just under 90 degrees after moving it around in 24 hrs.

*Day 21*
First visit to Physical therapy. Measured leg flexion at 78 degrees (?) and leg extension at 8 degrees. Did some basic stretching/mobility exercises. Pain level was minimal on the operation site, but my hamstring felt a lot of tension/pain at the last couple of degrees as I tried bending the leg. Was told I can apply weight and started using single crutch (will start transitioning to this and then no crutch as my leg gets stronger).

*Day 27*
Surgeon visit. He says I need to work on quad strength. Advices me to continue use of crutches/brace until strength is acceptable _(very important theme this week). _

*Day 28*
Third PT visit. The therapist (a DPT vs the PTA I had for session 2) was a bit more clinical and thorough with is observation and approach. But just like the surgeon said, I needed to build quad strength (which also means re-establishing neural connection to said muscle). Flexion measured at 107 degrees.

*Day 30:*
Not using brace anymore. Walking without a crutch is still somewhat difficult so I still use the crutch for longer distance walking (and going up and down stairs). Able to do a do full crank rotations but not without tightness/pain.

*Day 35:*
First full day with no crutches. Also spent a few minutes on bike with only slight discomfort on the knee. Leg is stiff at the end of the day.

*Day 44:*
Started doing some full weight bearing exercises on the repaired leg. I estimate that I only have 25% strength compared to the left (a long way to go). Flexion at 119 degrees but extension has not improved much despite daily PT. Some knee cap pain... probably because I'm moving more.

*Day 69:*
Started doing some trail riding a couple of weeks back. Have an ebike so not so taxing on the legs. I have more than enough range of motion to pedal even with the seat slammed all the way down. 
Leg is progressively getting stronger, and knee pain is diminished. However, I am experiencing shin splints after prolonged walks and PT sessions (also when on the pump track).


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## rockman (Jun 18, 2004)

Good luck with your recovery! I got 28 years out of my patellar tendon graft. Best thing about my knee when I got a TKR because of arthritis.

Take it easy on that knee cap. It's rare, but the harvest area is weakened and the cap can crack or break. Happened to my 22 yr old daughter.


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## edubfromktown (Sep 7, 2010)

rockman said:


> Good luck with your recovery! I got 28 years out of my patellar tendon graft. Best thing about my knee when I got a TKR because of arthritis.
> 
> Take it easy on that knee cap. It's rare, but the harvest area is weakened and the cap can crack or break. Happened to my 22 yr old daughter.


I am 18 years post-op of the same procedure. So far no signs of pain on FS, HT and SS riding (plus all day geared gravel rides).

Sent from my KB2005 using Tapatalk


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## angryoldman (Jun 15, 2015)

Hope it is going well and you are back to riding outside next Spring and inside soon.
Maybe some upper body weights soon as well

How did you injure it ? meaning what happened specifically during the game?and any way you think you could have prevented it?
Or just bad luck?

I am still playing some basketball, but injury fears are with me. I have a friend that injured his Achilles doing a home workout, so I guess you can get injured doing any activity or sport. Non cyclist frown at MTB riding, non road riders frown on vehicle traffic running me over etc.. It guess when it's time for your injury it just happens.


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## ron m. (Aug 1, 2009)

angryoldman said:


> How did you injure it ? meaning what happened specifically during the game?and any way you think you could have prevented it?
> Or just bad luck?


It was a combination of jumping and pivoting as soon as I landed (went after a rebound... got the ball tho... lol!). Could I have prevented it? I can't say. Someone said I would have if I had stretched prior... I dunno. I just remember my leg buckling laterally and me immediately going to the ground (the one time my mind reacted fast enough during the game, ironically). Bad luck would be if I got hurt because of an accident, but this was all on me. Ha!

What I hope will happen is that I don't severely alter my behavior, especially when it comes to riding bikes. I know my best basketball days are way behind me, but I feel like I still have a good decade of aggressive riding ahead. That's the hope anyway. I do intend to work on fundamentals more (bring the DJ to the pump track, etc) so hopefully this rehab period will give me a chance to hone those skills.


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