# ACL Repair: Autograft vs. Allograft



## shmrcksean (Jun 15, 2004)

I'm looking for any and all help and input to help me decide which path to go down in my upcoming ACL surgery. I am a 40 yr old male who recently tore his ACL and meniscus playing in a flag football tournament (yeah I know...but I can't stop thinking / acting like I'm 25.)

Upon my surgery consult today the Ortho gave me my choices and recommended the allograft (cadaver) over the autograft (my own patella ligament). I am currently dangerously armed with internet research and it seems like both are the same with the fact that autograft is better for younger, more active people where allograft is better for weekend warriors (like me.)

I typically ride 3-4 times a week, do Crossfit 3 times a week, and lead a pretty active lifestyle but have long given up on any dreams of sponsorship deals from anyone for my racing prowess (which there is none.) I'm looking for a pain free remainder of my days on my bike doing my 2-4 hour trail rides. Oh yeah...I typically ride a 5" travel trail bike and do the SS thing every so often (my wife got me an 29er SS for christmas so I have that to motivate me to recover.)

I'd appreciate any experiences (good and bad) from either type of reconstruction surgery to help me weigh one over the other.


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## spongstick (Feb 6, 2004)

1/3 of a allograft graft does die, but you will recover faster.But sometimes the Grafts are not very good,and the Dr won't know that until they open it on the back table during surgery. With autograft you can have Patella pain for years.So ask your Dr.about that.


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## thumper88 (Oct 1, 2008)

autografts on both, left at age 30, right at 35. Since no cadaver work, cant compare, but surely recovery is quicker with someone else's part since youve been cut on less, not a small thing.
But autos worked tremendously well, continued to play soccer and sail (tiled decks and major waves are tougher than it sounds) at very very high levels and both held up.
Get the work done as quickly as you can though and make them leave as much of the meniscus as they can, and I mean get second opins if they want to cut on it....with the first repair, I had waited several months to do it and the knee spun several times tearing up more cartilage, so they took a fair amount out, and what i had left is wearing down, prob a few years away from joint replacement, doc said. And that is the end of most of the things athletes like to do.


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## photorider (Dec 6, 2008)

*Go Allograft*

HI, I,m fifty this year and ripped my original out playing tennis. Finally had an Allograft put in 3 months later. Summer schedule wouldn't allow surgery any sooner. Leg attrophied pretty bad because I favored it for so long wating for a surgical oppertunity. Doc would only do the Allo because of my age. "Only young dudes can handle the hammy graft" he said. Well 3 months later I'm feeling great. I go to PT twice weekly and the gym every day in between. I'm told I'll be 99% in a couple more months with dedicated therapy. Spinner is my main ride now. The body just has to assimalate the graft with time. "_*Leg stength is the key*_". Many guys have gone without the surgery if you have very strong legs and the key is *hip and core strength* to compensate. Elway played for years with no ACL's in both knees. Brace is worthless. Leg strength is the brace. Go the Allograft route. FWIW Good Luck. PR


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## thumper88 (Oct 1, 2008)

It's true that some like Elway dont have problems, but every knee is built differently. Others can't walk down a flight of stairs without their foot spinning around to face backwards. Strength helps, but the structure of the knee is also a factor. Most people are somwhere on the scale between elway and constant stability issues. Mine spun going downstairs, stepping from a dock into a boat etc and I had an unusually strong set of legs as I was playing soccer four or five days a week and lifting at the time.


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## mlepito (May 1, 2007)

I do agree the the autograph should only be considered if you are more attractive.

The allograph is a much quicker recovery. The hamstring or patellar harvest takes longer the heal then the acl replacment surgery. That's why I chose the allograph. On my feet the next day, out of the brace in 10 days, back on the bike in 4 weeks, riding offroad in 4 months. (eventhough I felt great, you still have to wait for the bone to grow and take the graft).


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## EricD4 (May 11, 2008)

Autograft from the same knee, 6 weeks to downhill skiing, 12 years later, no problems. Like said above, "leg strength is the key". 

-E


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## shmrcksean (Jun 15, 2004)

*Going with the allograft*

After talking to some people, reading some posts and going over the pros and cons with my surgeon, I am going with the allograft. The doc says my knee probably wouldn't hold up for too long in the NFL but should be perfect for anything I can throw at my 40 year old body...riding and the annual flag football tournament included.

Thanks for the input...I should be good to go in 8 weeks according to the doc!


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## kuksul08 (Oct 8, 2006)

My martial arts instructor had the allograft and the recovery was very long. He stretched it a lot and worked it out gently, eventually he was back to normal.


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## traildoc (Mar 5, 2007)

shmrcksean said:


> After talking to some people, reading some posts and going over the pros and cons with my surgeon, I am going with the allograft. The doc says my knee probably wouldn't hold up for too long in the NFL but should be perfect for anything I can throw at my 40 year old body...riding and the annual flag football tournament included.
> 
> Thanks for the input...I should be good to go in 8 weeks according to the doc!


Sean:

Keep us posted as to how your rehab is going after your ACL surgery. I am 59 and had the patella graft on 9/18. I think the surgery went well. I only had one physical therapy appointment after surgery, but I have followed standard protocol exercises recommended by the PT.

In my case I rode a stationary bike a lot to gain range of motion. After 2 months I started to ride several miles on the pavement then at 3 months started easy trails off road.

This is not going to be an enjoyable rehab, but with luck you wll be happy you had the surgery 3 or 4 months from now.


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## shmrcksean (Jun 15, 2004)

*Done with surgery*

Had the surgery yesterday. Took about two hours and coming out of the general anesthesia, I felt great. An hour later, I felt like I could go for a ride right then and there. But of course, I was still pumped full of IV pain meds and the local had a few more hours to wear off. Hooked up the continual cold therapy machine and rested. I thought I would be doing jumping jacks today I felt that good.

Fast forward 12 hours and HOLY S*#T! It feels like some took a sledge hammer to my knee. I totally underestimated the pain following the surgery. The ice machine and pain killers take a little edge off but I will admit, this hurts. Now I know what everyone who had ACL surgery was talking about.

Follow up tomorrow with ortho and then start rehab. After feeling it today, I can't wait to have someone start manipulating it and moving it around. Should feel real good :eekster:

I know it's going to hurt but I can't wait to be back to normal again. I've got a brand new On One Inbred 29er SS hanging from the workstand with a box of shiney new parts beneath it. It's my motivation!


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## photorider (Dec 6, 2008)

*Welcome to the club*

Dig deep for the motivation to rehab as much as you can. Become one with the gym and a spinner. Like I said before leg strength will be your brace. I also used a cold therapy rig. After the first week when swelling had gone down I think a handful of those frozen blue ice bags would have been sufficient for me. At least much easier. Good Luck. :thumbsup:


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## ErickKTM (Jul 29, 2004)

The best is a Patel graph from uninjured knee. I had a allograph two year ago and it is doing good. But I didn't ride anything for 5-months, started riding MTB at 5-months and didn't get back on the mx bike until 6, which was probably still to early.It talks mainly about MX riders, but alot of it will apply to MTB riders.

Here is some of the best info on knee injuries and rehab.

First and foremost, MX is the most physically demanding and ACL demanding sport around. Compared to MX football is for wusses. I don't even have to bother comparing it to soccer, field hockey, volleyball, lacrosse and other sports that normal people who want to live to 100 years old participate in.


After an ACL rupture, the injured rider must start immediate rehabilitation. These centers on exercises to regain range of motion, strength, and a normal gait. We recommend Advil 4 tabs, 4 times per day, and the stationary bike one hour per day every day. It may take a few days to work up to this, but generally within a week an injured rider can do it. We don't recommend immobilization or crutches after a day or so. ABSOLUTELY CONTRAINDICATED IS EARY EMERGENCY SURGERY. I put that in caps because, when an operation is done acutely (right away) the risks of persistent stiffness is high. BTW, all the posts that talked about people's second, third, and fourth operations, came about because of stiffness, called in the medical field, Arthrofibrosis. This is entirely preventable if you wait and take your time.

Another question has come up regarding choice of graft. People have rightly opined that an allograft (from a dead person, usually an injured motorcyclist who was not wearing a helmet) will enable them to have the fastest recovery from the surgery. Those that opined that is possible to get AIDS from this graft are correct, but the chances are too low to be a part of the decision making process. Allografts would be the answer if they were live tissues. Unfortunately, they are dead (of course, they are from a cadaver). The athlete's body needs to replace this dead tissue with live tissue. This will occur over a period of a year. During that year, the only activity that is allowed is bicycling. Now, I know someone will say that they went back to riding at two months and they are fine. They would be provided they never have a bad get off. If so the allograft is in the trash. Most of Houston's local MX pros and star amateurs have had an allograft for their FIRST ACL procedure. I don't recommend allografts for MXer. They are fine for middle school teachers, who belong to a health club.

Hamstring tendon and patella tendon from the injured knee work. However, then the knee has to suffer from the operation and the ravages of the graft harvest. Harvest of hamstring tendons don't cause a lot of trouble when they are harvested, but since that tendon does not have bone at the end of it, the tendon much heal to the bone. This is an uncertain process and takes about eight months to a year to mature, in spite of new fancy and expensive screws. Remember, screws can't cause stuff to heal, despite what the commercials say. It just can't happen. Therefore the injured MXer is relegated to the stationary bicycle for a year. 

When the patella tendon is utilized, it has bone at both ends and bone to bone healing, which is highly reliable is complete in one month. Further the tendon is alive, and an injured MXer can be back in the bike as soon as his knee feels well. This usually takes six months. It takes six months because of the ACL surgery and the graft harvest. In fact the total temporary disability associated with the graft harvest and the surgery is greater than what you would expect from simply adding these two problems together.

So, to summarize, the patella tendon graft can get an injured MXer back by as little as one month post op, if the darn knee didn�t hurt so much. Six months seems to be the shortest period prior to return to riding.

We believe that we have developed a solution to this problem which can get guys back by as little as three months. As our Clinic, we harvest the patella tendon from the OPPOSITE knee. Our strategy is that we divide the problem amongst both knees. The ACL knee, get over the procedure rapidly, just like it would in an allograft case. However, this graft is alive, and is recognized by the body as itself. The bone blocks heal in a month, and the tendon stays strong in its new job as a ligament. By three months, the knee feels well enough to compete in MX, and its safe to do so because, the bone blocks would have healed and the living tendon stays strong in its new job.

Now, on the day of surgery, the opposite knee is started on a program to regain strength in the quadriceps. This continues for the same three months that the ACL knee needs before return to competition. By three months, both knees are good to go. 

Now someone may ask if now a guy has two bad knees. In fact not. Injured riders at our Clinic are able to walk 300 feet the afternoon of their surgery without crutches, and never ever utilize crutches, braces, or casts in the early period. (The choice of a sports brace after rehabilitation is the subject of another post) The day of surgery everyone is able to move each knee from hyperextension to 120 degrees of flexion. Although I recommend that guys take it real easy the first week, and spend that first week in bed, the wake boarder I did last Friday, took his girlfriend to a wedding that next day. 

Some may have heard that after a patella graft is taken people have anterior knee pain. That doesn't occur when the donor knee is not the ACL knee. 
Others may have heard that you can't kneel after this procedure. Again, this doesn�t occur when the donor knee is the ACL knee. For good measure, we bone graft the defects in the patella and upper tibia to avoid excessive stresses on the bone remaining. 


A few words about screws and such. At Sanders Clinic, we do not use screws to hold in the grafts. We tie heavy sutures over buttons which sit outside the bone. These buttons do not irritate the soft tissue and never need to come out. Furthermore, the tension in those sutures can be adjusted after I take the knee through 30-50 cycles of a full range of motion before I close the wound. With screws, once you put it in, you have to hope for the best, as if it�s too tight, the guy will never again fully straighten or bend his knee. The other advantage is that these buttons sitting on the outside of the bone will not cause a hole in the bone if they ever need to be removed for a revision of the ACL surgery and don't get in between the bone graft and the host bone, so healing can occur from all sides. (Remember, if the ACL is fixed perfect, and rehabbed perfectly, is not guaranteed against a really bad get off, and surgery may be necessary to rebuild it again. I don't mean to scare your guys, but as an MXer, I know what things can happen.) So, if revision surgery is necessary for a retear, it can be done in one stage rather than a first stage for removal of screws, and bone grafting, then another definitive operation 10 weeks later. Everything I mention is this paragraph is designed to avoid further operation that will not only cost us money, but take us away from our bikes.

Mark S. Sanders, MD
Houston, Texas
Cell: 713.907.6076


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## Broccoli (Jun 11, 2008)

Allograft only.

My wife recently had a meniscus tear repair and ACL reconstruction. A bit over one hour operation, started recovery immidiately, doing great now. Few tiny scars and she was watching the whole procedure on the monitor. (Yes, she is nuts)

From what we understood researching this, that was by far the best method. Getting to one of the top surgeons has helped as well.


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## shmrcksean (Jun 15, 2004)

*Getting better every day*

One week and a few days post-op, my knee is starting to feel pretty good. Still sore and plenty stiff and I'm still wearing a brace but walking with it in the unlocked position. My flexion at my PT on Tuesday was 130 degrees. I was able to do body weight squats wearing my brace to 90 degrees and have been riding the stationary bike with no resistance for 30 minutes a day. I returned back to work light duty on Thursday and am sitting at a desk doing whatever (I'm a cop and work patrol). The ortho says I should be good for full duty in 2-3 months.

I believe the ortho about the quick recovery of the allograft but I don't have any personal comparison to support it. But so far, IMHO, the allograft is the way to go.


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## Broccoli (Jun 11, 2008)

shmrcksean said:


> I believe the ortho about the quick recovery of the allograft but I don't have any personal comparison to support it. But so far, IMHO, the allograft is the way to go.


I remember being told is that the graft is at its weakest few weeks after surgery, when it start to vascularize and when the attachement points grow in (they used some bio absorbed screws, or something like that in our case). So our doctor asked to take it easy for a while after working on the range of motion. I amy be mis-remembering.


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## ATLRider (May 12, 2004)

shmrcksean, I am impressed with your recovery. I had ACL/PCL replacement in mid December and am just getting to 130 degrees. Only in last week could I spin the stationary bike without feeling a ton of resistance. I have been doing my pt everyday at least once sometimes twice. I went allograft as well.


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## danoalb (Dec 19, 2005)

Had a autograft 6 years ago in late March and was skiing full tilt by December (would have been alot sooner but needed snow). Knee feels great and is strong as hell. I suggest you work on your range of motion very diligently the first few months and don't stress the muscles too much. I'm 55 now and I can still do all the things I used to do and then some. That being said the Patella graft is very storng and heals very fast considering what it is. By the way I was biking again after 1 month.


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## ryanc104 (Oct 30, 2008)

i had an autograft ACL reconstruction at 16. broke my femur in a football game and after the rehab 6 months later found out i only had 1/4 of my ACL. i haven't had any problems with my patella tendon. its actually stronger than my left knee. its been 13 years. i have had three more surgery's but that was for meniscus tears and pseudo gaot. i still played football and baseball my junior year. and just like you im very active with it now. the big thing is just to be aware of your limitations. ortho doc said to lay off the heavy squats and leg extentions. good luck with the rehab and getting back on the saddle.


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## fastmike926 (Oct 8, 2006)

With an Allograft your knee will feel better sooner because the surgery is less traumatic but it takes 1 year to 18 months for the dead graft to revascularize and reach full strength as opposed to 12 weeks for an autograft. revision rates among allografts are 30% because of stretched grafts as opposed to 5% for an autograft. You should be ok as long as you are willing to stay away from sports for 1 to 2 years.


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## shmrcksean (Jun 15, 2004)

It's been 7 weeks post op and my knee fells almost 100%. I have full range of motion and there is no pain walking. I started riding my road bike last week and after riding 30 miles on a SS road bike (flip flopped from the fixie to freewheel for the healing process). It swells up and gets stiff after a ride but in a few hours, it's back to good. I realize the allograft feels better but takes longer to complete heal and don't plan on playing any football or basketball for the next few months. My surgeon says I will be released for full sports six months post-op. 

I am still doing my rehab religiously...stationary bike, leg strengthening exercises, balance exercises, etc. So far, so good. I keep looking forward to knocking each week off my 6 month time frame so I can ride in the dirt again. It's killing me to go into the garage every day and see the bikes sitting there bored!


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## RDI (Mar 14, 2005)

Had ACL w/Allograft January 6th. Talked at length w/my doc about auto vs. allo. Doc.said after 35 better to go w/allo because your tissue does not regenerate to the degree necessary for stability. He also said that because people, especially teens early 20's feel better faster w/allograft, they tend to go back too soon and that is the basis for the prevailing medical oponions as to why younger people re-tear at a higher rate w/allo's. Doc. told me not to ski for at least a year and only to return to riding @ 6 months but use platforms.


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## photorider (Dec 6, 2008)

*Rehab Rehab Rehab*

I had Allograft inserted the last week of Aug 08. Rode the spinner to begin rehab before surgery and have put in many hundreds of hours since. PT twice a week for four months and supplemented that with my own gym leg and core routine. The Allo is only a supplemental form of stabilization. Leg, hip, glut, and core is what will do the work of the lost tendon. I have put in a couple of hundred miles now on my new Niner and feel great.


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## RDI (Mar 14, 2005)

Hey Photorider. Glad you're doing well! My PT has me working on all that Glut, core, hip, leg, but I've been in rehab about 2 months and she's talking about cutting me back to 1x a week as long as I continue working out on my own. I'm not exactly sure - I've heard that most people stay in rehab at least 3 mo. 2x week. My doc. is a big sports med. and he highly recommended this PT. Anyone have any thoughts about how long to keep seeing the PT?


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## Wildeyes (Jun 14, 2007)

As much as you can afford really. For soccer, rehad was 9 months long at 3 X's a week to get back to minimal performance. I would also go with your own tissue and not that of a cadaver. I have had friends do the cadaver thing and it ripped/died in the long run. They ended up getting the surgery again with their own tissue from the patella used.

ACL=2nd worst rehab ever. The worst for me was abdominal surgery to secure my muscle back to the proper place. When the doctor at Duke tells you the rehab is going to be unpleasant- even before the surgery- you know it is going to suck. 

Don't skimp on rehab for ACL, especially at higher ages. You will end up getting more surgeries down the line on cartilege and bone spurs if you don't do it "right". I speak from experience. 1 ACL- 4 surgeries after to fix cartilege and bone spur issues. Eventually I stopped playing soccer an just started biking and all problems went away.


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## ThreeMan (Mar 24, 2009)

Shmrck, 

I feel your pain. Torn both ACLs. The left first, then right, and then the left a second time. Had the patellar on the left and the hamstring on the right. Used interference screws on the left and buttons on the right. Both harvested form the injured knees. Just borke the patellar in the left knee again last November. Apparently I have reached the useful life of a graft of 8 years, 8 to 10 is the norm. Have yet to repair it and can ride the hell out of my bike. As far as recoup time. Had surgery in november on the first left and was playing in a college lax game in Feb. Nowadays three to four months then full on go. ALso depends on tolerence of pain as you recover.

Different doctors do different things In response to your question ther are a few. One difference is the cadaver has the most risk for infection, look at Brady. I am not sure which graft location I would prefer. Both knees had plus and minus sides. The left was a little stiff, but feelt more stable. Rehab was faster as well. I had a better range of motion in the right, but I still wear a brace when playing racquetball and such avtivities. Never regained comparable strength in my right hamstring, surgery was in '04. (I live in the gym)

I recommend that you take in a few more opinions. Different doctors and different procedures as well. This was a great idea taking in other opinions to help you get informed and maybe give you more insight on what you are in for.


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## hwiser09 (Jan 31, 2010)

thumper88 said:


> autografts on both, left at age 30, right at 35. Since no cadaver work, cant compare, but surely recovery is quicker with someone else's part since youve been cut on less, not a small thing.
> But autos worked tremendously well, continued to play soccer and sail (tiled decks and major waves are tougher than it sounds) at very very high levels and both held up.
> Get the work done as quickly as you can though and make them leave as much of the meniscus as they can, and I mean get second opins if they want to cut on it....with the first repair, I had waited several months to do it and the knee spun several times tearing up more cartilage, so they took a fair amount out, and what i had left is wearing down, prob a few years away from joint replacement, doc said. And that is the end of most of the things athletes like to do.


i think it's best to follow the doctor's advise. It might be risky if you will pursue on autograft.


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## dru (Sep 4, 2006)

EEEEEEW!!!!! 

Allograft= corpse parts.......

Sorry, that grosses me out.....

I got the patelar graft 18 years ago and all is good aside from some occasional pain from what little meniscus I have on the inside of my repaired leg.

The pain from the surgery was brutal and it took a long time to get full range of motion..... but my knee is ok...

I'm just screwing with you allograft folks...... 'cause I'm like a five year old....

and 'cause it's gross.....

Drew


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## prphoto (Mar 17, 2006)

I did autograft at age 37, painful but I did pre-hab and did North Rim of Grand canyon to Zion Nat'l park 6 weeks later. I'm going to respectfully suggest that you ditch the ss.


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## Broccoli (Jun 11, 2008)

dru said:


> EEEEEEW!!!!!
> 
> Allograft= corpse parts.......


Yes, just like any other donor part. Better to chop a spare piece from somebody who does not need it anymore, is not it?

By FAR the superior procedure, by all accounts...


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## dru (Sep 4, 2006)

Hey I signed my donor card. 

I'm all for giving away my vital bits if I croak....

but it's still gross.....

(remember, I'm 5....)


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