# I Am Done - Torn ACL News This Morning



## Techz (Jul 10, 2007)

Impact crash to my patella and I have a torn ACL..........first opinion=reconstructive surgery! 6-12 months recovery. I could not believe what I was hearing.

I saw some brainy health advice in this forum before. You all might be able to help.
Referrals requested for a spectacular ortho surgeon needed for second opinion outside Kaiser please PM me. I already have a second scheduled with Kaiser. Want a third, fourth or fifth. Any Drs. in the house? I know ACLs do not heal but how do I know that it is completely torn. Got an MRI and xrays. Not 100% conclusive other then clinical tests and mobility techniques. From MRI Drs. quote "it is swollen and definitely does not seem right to me". He did not say there is a gap between 2 halves of ligament. WTF. I am going under the knife for that. They put me under and dig around and - oops! this guy aint got nothing torn!


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## Brentster (Jun 17, 2007)

That sucks SO bad. I guess "Get well soon" doesn't apply here. Good luck buddy.


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## presslab (Jan 5, 2007)

I guess it's the opposite for me. I've had a torn ACL for 1.5 years and Kaiser dragged their feet and didn't want to fix it. I've torn my MCL from the bone about 20 times now because of it. Ouch.

Finally back in January they agreed to do the surgery, and next week it should be done!

Try this test if you can: Sit on the floor and rotate your bad leg at the hip so the inside of the knee is facing the floor. Bend the knee about 15 degrees from straight. Relax the leg (important) and gently push down on your leg just above the knee. With my bad ACL the knee joint will slightly separate and the lower part of my leg will visibly rotate a significant amount.

If you have a spare $15k, Dr. Sanders is an expert in ACL reconstruction and sports medicine.
http://www.sandersclinic.net/


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## mlepito (May 1, 2007)

If the MRI in inconclusive for the tear then the "slices" taken must have missed it. The ligament is not the thick. You have several options. 

1. get another MRI and hopefully they can see the entire ligament or lack there-of. I would recommend waiting until the swelling goes down a bit. Fluid on MRI lights up like a christmas tree.

2. wait for the surgery and see how stable you knee really is. You can always have the surgery later if your knee is too loose. Unless you fall again and the lack of the ligament causes torsion and further damage. So you have to be careful. But several people walk around with no ACL.

3. Have a scope first. That way they can see the ligament first hand, no wide open surgery.

Here is a reassuring thought. They can do ACL replacement arthoscopically now. With the right rehab and an allograft, you can be walking the next day, on the bike in 4 weeks, and off road in 4 months. I know, because I did it. Surgery in December, riding trails in April.


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## Techz (Jul 10, 2007)

mlepito:
Thanks that is uplifting advice. Swelling is down. Kind of non-stable rubbery feeling. Can the scope be done the day of surgery to make the descison? What is you percentage back.....80, 95?

presslab:
Tried the test, hopefully right, maybe a cm. of movement.


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## presslab (Jan 5, 2007)

Do you feel it rotating and coming apart? It will have that sort of 'that shouldn't be happening' feeling.

I had a preop appt. this morning and I showed the surgeon's assistant how it comes apart. She was impressed with how much it moved.

There is the Lachman's test too:
http://en.wikipedia.org/wiki/Lachman_test


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## mlepito (May 1, 2007)

They would do it at the same time. If they scope and there is no tear, they stop of course. If the tear is there they replace it. Like I said before, if you are worried about the scope, you can get another MRI to get a better look at the ligament.

I would say I'm 85-90%. It still feels funny and it sometimes feels unstable but when I move on it, it's fine. I ride with no problems. But to be honest I rode with the ligament torn with no problems. It was when I took some time off due to rain that my knee started to really get loose.


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## Techz (Jul 10, 2007)

Spoke to paramedic friend of mine whose friend is an ortho surgeon. He asks him so what you do today and he says "a couple knees and a shoulder before lunch and a couple more after". I guess this is a very common procedure and I shouldn't be worrying so much.............like an everyday thing. It is not like I had a catostrophic knee blow out like football players. Comments like knee reconstruction and 6-12 months is hard to take but thanks all.


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## mlepito (May 1, 2007)

Just keep in mind, it's not like this is the last year you will ever ride. Taking the proper time off now will insure many years of riding in the future. Keep that in mind when you do your rehab, and it will pay off.


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## thetreadway (Jun 29, 2007)

I'm one month out of surgery. ACL with my own hamstring as graft material. I'm walking with no brace and riding the trainer two or three times a day. Its getting better and the swelling is going down. I'm working hard on extension and flexion. REHAB REHAB REHAB like its your job only work harder on REHAB than you do on your job!!!


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## Techz (Jul 10, 2007)

thetreadway:
Got it! Did they give you a choice to graft a piece of your patellar tendon...big strap along the outside of your knee across the knee cap. What about a cadaver ligament? My doctor said they got issues with infections and dead tissue when it is taken from a cavdaver.


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## borregokid (Feb 18, 2004)

I tore my medial, lateral and ACL in one accident. I am also a member of GHC which is affiliated with Kaiser. I went in and had arthroscopic surgery. When I came out the physician told me I had a torn ACL. I took a week off the bike and then started biking again. The surgeon for GHC said anytime I wanted to I could have ACL surgery. I opted not to have surgery. It hasnt slowed my biking down at all. I cant run up stairs like most people and I really cant run but I havent really thought about surgery. Anyway I thought I would throw this out that there is a "no surgery" option that I am sure a lot of people opt for.


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## k_rust (Apr 26, 2004)

I tore my ACL in half 4-5 years ago playing soccer (I heard/felt the "Pop", very loose knee after it "healed", no ligament showed up on the MRI...) I did wait till the swelling went down to have a MRI, then was told by Dr #1 and #2 I absolutely had to have surgery, Dr #3 said I should buy a custom ACL brace instead and wear it when I played sports like soccer, basketball or skied (any twisting/pivoting sport). I started cycling and am now racing pro in the NMBS series.

The knee has really tightened up due to the strength of my leg muscles and I almost never notice any issues, none when on the bike. I was told if I quit cycling at this level my muscles _may_ not protect the knee as well and I might have to consider surgery in the future. Recently I visited another Ortho Dr for something else, he checked my knee and said I did the right thing in avoiding surgery. 
(If I wanted to play soccer instead of riding my bike, I would have the surgery.)

Hope this helps a bit, good luck!
Krista


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## Atomick (Apr 22, 2008)

My GF tore her ACL and as a result she broke her leg in the Sierra Nevada. All her weight came onto one leg that slipped on a rock, and her knee just let go...and this was not the ACL tear, that happened 4 years ago (another lovely Kaiser misdiagnosis/ignorance)...but it still led to a blown vacation (day 1 of 9), two rangers, nine firefighters, 1 hour of stretcher-carrying through the woods, a helicopter airlift...ugh.

Recovery for her is going great; 6 months later she's hiking up 30% slopes with trekking poles, jogging with her brace, and biking without knee support. But she's also hyper-obsessed with doing her therapy exercises every day. She's a trooper! (FWIW, she got an allograft, rather than a hamstring graft, from some dead guy's ligament. Zombie cyborg, that's so hot! )

Our experience was that it was pretty easy, all told. Pain in the butt, tons of logistics, long road to recovery, and time consuming (for the PT). But she's got tons more confidence, and the surgery itself was a slam dunk.


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## Techz (Jul 10, 2007)

Leave it to MTBers to be helpful. Thank you. K_park has provided some inspiration here. I can XC on it all day, its when I thrown on the full face, elbows and knees that I am concerned. At this point it is loose and rubbery. At the gym I can't do the calf lifts with one plate (the one where the weights are at your ankles but the weight is lifted with your shoulders).

Got fitted for a custom leg brace today and received some references for an ortho outside Kaiser Sosey. 

Check this out, the Kaiser ortho setup the second opinion with someone he got published with and studied with under the same Dr. at UCI Med. Center.


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## ripper1 (Jan 12, 2007)

What the hell is this Kaiser that everyone refers too?

As u may see in the forums thread, I had my ACL operation 3 weeks ago yesterday. Hamstring graft.
The bottom line is if you want to get your knee back close to what it was, AND you don't want to have further damage done to ya knee every time you jolt it or twist it or fall off ya bike, then the knee re-con is the sensible way to go.

As my $pecialist said "Don't have the Op is ok, but you'll have to modify your lifestyle, or you run the risk of completely trashing your knee or going thru a lot of pain each twist" 
I wanted to get back out there and not be in fear of that next bump would cause the pain and swelling all over again. 

Now its a bummer not riding, surfing, skiing etc for the next 6 months, but this time next year I hope to have forgotten all about it and have a good strong knee again and doing stuff.

Like Treadway said, Physio, physio. Hurts a bit but the improvement is there every day. Time goes fairly fast and I'm walking reasonably well at this stage with no pain
Good luck which ever way you go.


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## Techz (Jul 10, 2007)

ripper1 - Kaiser Permanente standard HMO (health managment organization, I think), managed health care and you cannot select any Dr. you want.............KAISER KILLS!

You feel like saying MOOOO! walking in.

Yah from what I hear the rehab/PT is more than 50% of a successful op.


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## ripper1 (Jan 12, 2007)

Wow, don't like that idea where you cannot select your own doctor despite having Private Health cover.
Fortunately my health fund here in Australia covers my Specialist of choice (the one I was referred to) and most Private Hospitals. The use of the hospital for my Op and the overnite stay cost me $50 instead of about $2000. Mind you, I will still have to pay a fair percentage of the bill for the specialist and aneathesist when they arrive in the mail...soon!!


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## Techz (Jul 10, 2007)

Yes, there is good and bad with Kaiser. My surgery will cost $100 with a specialist from a world known med. center.......UCI, thats University of California Irvine (not sure if you knew what UCI was or not). Pain meds = $50 Wow, responses far and wide-Australia. How much comes out of your pay per week on average going to the government for healthcare?


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## thetreadway (Jun 29, 2007)

I opted for using my own Hammy as the graft material. It hurts and is maybe a little more work to get your hamstring stretched back out but, the literature says your own hammy is stronger than the cadaver and without all the obvious scary possibilities which are slim but still there. I'm one month out and walking pretty well and getting my flexion and extension back I'm at 126 degrees of flexion and almost full extension. Don't sweat it too much, they do these all the time. Just work hard on your PT and you'll be riding trails in 5 or 6 months....I hope!!!


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## RSW42 (Aug 22, 2006)

Both my Ortho and Sports MEd Docs say my ACL (partial) tear happened years ago...most likely on a parachute jump or other "on the job" stuff...

I had an ACL strain this past July, and they did the whole MRi/exam thing again, and the Surgeon told me: "We could operate on it, but my goal would be for it to be as strong as it is now"


:thumbsup:


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## cazloco (Apr 6, 2005)

*good story*

My girlfriend completely tore acl, ripped mcl and tore the miniscus thingy on the 27th of April this year (skiing) Surgery was last month and she walks without a brace now. Rides a trainer several times a day, swims, works full time (not at a desk) and REHABS CONSTANTLY. PT says she'll be running in a month.

Surgery took less than two hours. Was at the hospital for five hours total. She had an MRI but the doc said that they wouldn't know the condition for sure until they get in there. Thats when they found the ripped miniscus. Doc said to use her hamstring for the ACL because it's her's and there'd be less complications during recovery. Also said that the Patella graf takes longer to rehab.

She had the work done in Eugene Oregon at SLOCUM.

Do it.

Caz


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## JMK331 (Mar 9, 2008)

This info might be too late but. I tore my MCL and ACL and fractured my tibial plateau. I flew to Houston and was fixed up by Dr. Mark Sanders. Never used crutches, no braces. Started walking a few hours after surgery, started stairs, squats and ridin the bike a few days later. Was back riding motox less than 90 days. Check out the injury forum at thumpertalk.com his cell phone number is in his signature. Helluva guy. He takes most insurance and will pay for your travel expenses as well as hotel for you and a significant other. Good luck! His website has some impressive videos. sandersclinic.net


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## Doggity (Mar 27, 2007)

My brother tore his ACL on a backpacking trip with me. He rotated his leg wrong under full weight, heard a loud POP, he started hollering. He couldn't bear any extra weight, but he determined he could still walk, and would rather do so, than be airlifted out. So I Aced his knee with a 6" ace, and told him 'Don't take this off til we're home" Guess who carried both packs. He got his knee scoped when he got home. All they did was 'clean it up, take out the pieces'. So he doesn't _have_ an ACL in his left knee. He runs, lifts weights now like nothing ever happened. Maybe he doesn't know he's not supposed to be able to do that?


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## ripper1 (Jan 12, 2007)

If he does physical stuff He'll eventually do untold damage to his knee to the point where he will have constant swelling and pain and his knee will crap itself. Best to have the reconstruction. It's not that bad, I'm 5 weeks out of the Op and getting better every day


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## Techz (Jul 10, 2007)

Anyone got news on the hammy graft, patellar tendon graft or allograft (corpse).

Got my second opinion today same news 9 mm movement in right knee and 14 mm in bad knee. Side by side in strength tests the hamstring is the strongest but it is a tendon and must grow itself to the bone. The patellar tendon is what I am leaning towards. They actually take a piece of bone out with it and plug the bone tunnel with it and it grows together to fill the gaps. Supposedly this is the means pro-athletes choose.


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## ripper1 (Jan 12, 2007)

Your specialist will tell you what he prefers and why. Mine specialises in only knee re-constructions and he does the hammy tendon "every time" now instead of the patella. I believe the recovery from the patella option takes a lot longer and the knee movement later is not as good. I would not like my Patella tendon messed with to be honest. 5 weeks today since the Op and I would never know my hammy has been effected. A bit sore for the first couple of weeks though. Now after a heap of PT, the hammy, the quad and calf muscles are starting to regain their strength. Exercise bike no problem, 2 twenty minute sessions a day, NO pain.
Good luck


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## presslab (Jan 5, 2007)

The following info is based on my internet research.

The bone-patella-bone autograft has been considered the 'gold standard.' I just had the hamstring autograft. The morbidity (complications) of the donor site is lower than patella, and the overall strength is about 1.5x of the patella. It does take longer to heal but there are some studies that show it is not really that much longer.

I have patella-femoral syndrome on the bad knee so that was a contraindication to the patella graft. There is the option of the opposite patella too; this is considered by some to be the best graft source for fastest recovery, however my surgeon did not want to do that for various reasons.

The allografts have a much higher rate of failure than autografts and there is also a possible risk of infection. I consider these a last resort.

I am almost 2 weeks post reconstruction, staples came out today. I am walking okay and going to start on the stationary bike in a couple days.


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## ripper1 (Jan 12, 2007)

Staples? Bummer. I had the dissolving stitches, now there is just a faint line of a scar.
Don't even think about that exercise bike just yet, you need to be guided by the Physio. Give it approx 4 weeks on the proviso you progress well thru the excersises. Otherwise you will cop pain and untold swelling, and that means consistent pain!! Swelling is your enemy right now, you have to control it and reduce it. NOT imflame it.. I started wearing a compression tube bandage soon after my brace came off (10 days) and that really helped reduce swelling. The only time I dont wear it is when I'm sleeping, or icing after an exercise session. Now at 5 weeks my knee is even looking more normal...getting better.


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## presslab (Jan 5, 2007)

The staples were on the largest donor incision, about 2" long. They looked cool.  The surgeon said I could walk w/o crutches when I felt like it, and for me that was the 2nd day after surgery. The surgeon said stationary bike at 2 weeks along with other PT, and at this point some light stationary biking seems like it will get things moving along.

For whatever reason I have had very little swelling, even the nurse today was quite impressed.


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## ripper1 (Jan 12, 2007)

WOW walking in 2 days...you are doing real well. I had the brace on for 10 days, and only took it off to exercise. Talk about a pain in the arse!!
But my specialist is fairly conservative and was adamant I could do damage unless I took it easy and followed instructions. The worse thing would be to damage the graft. I've been told the graft tendon is at its weekest at the 6-8 week mark and care must be taken. Thats why the physical exercises really start at the 10 week mark.
Check this page on rehab, and other details, some really good info. http://ehealthmd.com/library/acltears/ACL_rehab.html


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## EricD4 (May 11, 2008)

I tore my ACL 10 years ago now skiing. I tore it in November, skied the entire season with a brace (My choice), had it repaired with a patella graft from the same knee. Rehabed like crazy and was out mogul skiing (with a brace) 5 weeks post surgery. I skied once more that spring and took the summer off from skiing. Picked-up again in the fall with out a brace and have been averaging 30+ days per winter and well over 1,000 miles every summer since. My advice? get the surgery done, be dedicated to the re-hab and you'll be back to your old self in no time. I had a great Dr here in Fort Collins (CSU Football team doctor). PM me if you have any questions or need his name. Good luck to you!

-E


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## Techz (Jul 10, 2007)

This is all great news. Got my custom ACL brace today to protect it now while riding.

Got some confidence from the Kaiser sports ortho. They said I would be hard pressed to find a group of Drs. that do more ACL replacement then them. First I was thinking sales pitch but after some more thought I figured it may be true based on that fact at the sheer size of Kaiser these days and that everytime I need a follow up with the sports ortho it is a month out. It sounds like ACL replacemet these days is a walk in the park ..........or limp!

The second I got stated that specifically with MTBrs there is some minor wear on the back of the patella that he has seen alot and it is just part of our sport. He also stated that he is concerned with MTBrs being tooooo adamant about hammering out the PT too soon damaging the graft. Lets face it we like pushing ourselves and by the sound of all the above it is true.

Presslab, that is F___g awesome walking in two days. Where your pain meds methamphetamine? All your storys are boosting my confidence to get the surgery done sooner than later. I like the Drs. quote " we use a method called bone tunneling".


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## presslab (Jan 5, 2007)

Pain was not bad at all. I think I took 4 Vicodin in all.

Rode the bike 2 weeks after surgery, just flat gravel paths. At 3 weeks I rode at Annadel, did some hills. The quad muscles on that leg are visibly smaller, it's pretty surprising. All in all not bad, I can even walk up stairs, one foot after the other.

I didn't mention the biking to the surgeon.  But he said that I can push my PT, whatever I feel comfortable with, let the pain be my guide; but don't do anything to damage the graft.


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## 64mtnbiker (Oct 31, 2007)

*torn acl*

I had a scope done in 87 and then total acl repair done in 95 on the same knee. When I had it checked at the surgeons office the 2nd time he wanted to drain the fluid to see what color it was. He told me that the darker the color the worse the damage is. Mine was a pretty dark shade of pink. Surgery lasted about 7 hours. I've got 3 screws and 3 bone plugs holding it together. They grafted a part of the patella tendon to repair the acl. I've been riding on it ever since. Hope this helps and good luck.


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## coop27 (May 30, 2007)

*more acl fun*

I had my acl reconstructed with an allograft 13 years ago. Doing great. Back then they offered me my own patellar tendon or an allograft. A lot here has been said about allografts having a higher failure rate, but a lot of that is dependent on which sterilization procedure is used. Some studies have found equivalent results, some have had quicker rehab with allograft, and some have showed higher re-rupture rates. Ultimately the decision has to be individual. Hamstrings are definitely becoming more common because it is common to have slower rehab and more anterior knee pain after a patellar tendon. Some people probably are good candidates for no surgery, but there is a risk of chronic instability and further cartilage and meniscal damage. 
The bottom line again is that the treatment doesn't have to be the same for everyone. I was in high school when i first tore mine and played three years of high school tennis and surfed every day before finally having it fixed. Some people have more instability problems than others.


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## nebulus911 (Aug 5, 2008)

I've had two ACL reconstructions. Tore the ACL and meniscus, had a patellar tendon graft and recovery hurt like hell (mainly from the graft site). Tore the ACL graft in 2005 and had a revision sugery. Second time around they used an allograft, and I got buy without any pain meds. Recovery was a breeze.

One thing to note about ACL tears. Tearing the ACL doesn't necessarily mean that surgery is required. Two groups exist: Copers and non-copers. If you're living with a torn ACL, have no give-ways, and minimal perfusion (ie swelling) then you might qualify as a coper. Studies have shown that if you meet the previous criteria, have >90% quad strength in the injured leg (as compared to the healthy leg - measured using a burst test), and score >90% on a hop test (various hopping exercises comparing injured leg performance to uninjured leg performance), then you could probably return to biking without incident. This criteria is used in some college PT clinics as a decision tool for determining which athletes can return to sport after ACL injury. This applies to cutting sports (eg soccer, football, basketball). Obviously, the athletes return to sport with the addition of a knee brace. So, you could possibly bring this up with your doctor, or if he seems oblivious to this research then get a script for PT and try to find a clinic associated with a University or minor/major league sports team. It could be worth the peace of mind knowing knowing that you can avoid surgery and not expose yourself to any increased risk of cartilage, meniscus, or further ligament damage.

For the nerds out there, here's some good reading material: http://www.udel.edu/PT/snyder-mackler/#PUBLICATIONS


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## Fibula (Oct 20, 2008)

1) You don't need an MRI to diagnose a high-grade ACL tear.
2) Most ACL recons now can be done arthroscopically-assisted and take a LOT less time to perform than an open procedure. The surgeon will usually do a knee scope and check out the rest of the joint anyway and do whatever fixing needs to be done. Obviously if your ACL isn't torn, s/he is not going to reconstruct it.
3) Fresh Frozen Allgraft is usually the better option.
4) Staples are better than "dissolving" skin sutures in terms of scar. In fact, staples are better than most sutures for closing skin. It's a different story when the staples have to come out, however.


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## Techz (Jul 10, 2007)

So...I started this thread and Monday will be 6 weeks since my surgery. I chose the patellar tendon graft. It is going well. I am on the trainer with road bike. I have daily swelling along with daily icing and elevation. Outpatient PT two times a week and everyday at home. I am a bigger guy so my flexion is going slowly. I currently have 125 degrees with a goal of ~ 150 or touching your butt with your heel. I have 0 degrees extension (straight leg) but I am always swollen so you really can't tell. I need about ~ -5 degrees to match the other knee.

I still have a slight limp but expect to be riding in the dirt in 3-4 months. PT is turing out to be a real chore but the challenge is fun and I am already strength training. Right now my quad is concave and deteriorated which took about 2 days due to the trauma of surgery, typical.

All, take it for what it is worth but Kaiser turned out to be better that I would have ever expected. They have treated me well, all in all. Initially I had many reservations. I had the sugery done at the Sand Canyon office in Irvine, CA.


I AM SUPRISED THAT THIS THREAD IS STILL GOING. EVERYONE THANKS FOR ALL THE INPUT AND ADVICE!


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## Techz (Jul 10, 2007)

Oh yah...........stoked............my meniscus was pristine with no tears. Right on.


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## JMK331 (Mar 9, 2008)

That is good news. It sounds like you are on the right track. Rehab, rehab and more rehab. If you need ideas to increase your extension let me know. Proper extension is the key to no limp. It some cases it can alleviate any pain you might be having under your patella.


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## thumper88 (Oct 1, 2008)

ripper1 said:


> If he does physical stuff He'll eventually do untold damage to his knee to the point where he will have constant swelling and pain and his knee will crap itself. Best to have the reconstruction. It's not that bad, I'm 5 weeks out of the Op and getting better every day


Get the work done. I can tell you from sad experience that if you dont, ASAP, you will need a knee replacement in middle age. I've know a couple of people who didnt get the work done, including a Navy SEAL who concealed it from his command so he could stay in the unit. His knee was built differently from mine, and like many people he was able to do more without spinning it so foot faced backwards, at least too often. But both of us are 47 now and I'm looking at a replacement in a couple years and he just had one.
He really IS "done." No more serious sports, no more hiking etc.


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