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429
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12/4/2013
Location
Arlington Heights, IL, USA
Hey guys,long story short. I crashed back in April and hurt really bad my left knee,I kept riding all summer and 2 weeks ago when helping my brother it pop out.So I finally went to a doctor and it turns out that I torn my ACL.My question is do any of you have experience or any info with stems cell treatment?Some say that is better then operation ,other say that it's not and you cant really trust that kind of a doctors.Any info will be hopeful.Thanks
If your ACL is fully torn, I don't think stem cell would even work because they need to reattach it, that is why the long recovery for ACL injures.
I tore mine in 2 in 2007. I lived with it for 6 months then had a patellar graft done to repair it. In 2007 the practice was to install the ACL vertically, which worked unless I twisted my knee, which then positionally made it useless. Because of that, my meniscus took damage until it tore and flipped over (bucket handle tear). I had 1/3 of my meniscus removed and a second ACL graft installed in 2014. The second graft was a hamstring graft and was put in at a 30 degree angle to add stability when my knee is twisted.
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All the procedures can work, but the here are the facts.
1. Cadaver grafts fail a lot more. They have no business in an athlete, or someone who rides MX. They will also take a lot longer to get to full strength. (2 years+)
2. Hamstring grafts should be stronger, as the raw graft material is stronger than patella tendon...but they are not. They fail at a higher percentage than PTGs. This is probably due to the superiority of the bone to bone plug healing of the PTG, and the ability for a skilled surgeon to get autograft "installation" length just right.
3. Any one person telling you that you should get a specific procedure done because they had it done, and it went well, is spewing nonsense. One instance is not statistically significant. That is why they do medical studies. READ the studies..and look at statistically significant percentages. Don't be lazy. Do the work, and trust your ability to read and understand the studies. They are not that complex once you get past the medical lingo.
Here are some studies you should obtain and read:
-GRAFT SELECTION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
-Rehabilitation Program for Both Knees When the Contralateral Autogenous Patellar Tendon Graft is Used for Primary ACL Reconstruction: A Case Study
-Biomechanical Comparison of Hamstring and Patellar TendonGraft Anterior Cruciate Ligament Reconstruction Techniques:The Impact of Fixation Level and Fixation Method UnderCyclic Loading
One thing you MUST understand. Doctors have a monetary interest in doing a Cadaver graft. This procedure is much shorter, requires less skill, and the cadaver graft is a buyout item they can "mark up". For a surgeon, specializing in cadaver grafts and selling patients on them can boost their income a lot, as they can perform more surgeries on their "cutting day".
This is why you learn science and lingo before you let a doc "sell" you on which procedure to use.
This is why the Lachman Test is the best indicator as to whether knee surgery should be done. It is better than an MRI, because it establishes if the ACL is still functional, and carrying loads.
I initially went to see an old friend of mine who is a knee surgeon. He did a Lachmans Test..and said...you gotta get it fixed..your ACL is gone. But he wanted to do an MRI just to see if there was other damage. (Turns out I had major bone bruising / microfacturing under the joint...which is was not good) The MRI showed only a mild ACL tear, and gave no indication of how badly stretched or deformed the ACL was. He said no surgery...just take is easy. I asked why he changed his tune, and he had no answer.
I went to another doc with a lot of MX rider treatment experience. Showed him the MRI. He laughed, and said that it does not matter if it is stretched, partially torn, or gone. If it is not functional, it needs full repair, or you need to quit being active. If you stay active, and the loads in the knee shift to other load paths...you will damage them because the knee was not designed to carry those loads. The ACL is there for a reason. Being an Engineer who understand structures and loads, this made a ton more sense than my old friend who changed his tune after the MRI.
Like stated above, research Dr's in your state. I drove 3 hours for my second surgery to a Dr in Detroit who specializes in young patients (most othropeds are hip and geriatric knee pros). My guy specializes in knees and elbows in young patients exclusively and did his internship with the Yankees.
ASK your doc how many times he has done the procedure. For reference...Shelbourne has done 10,000+ Patella Autografts. Think about that. 3-4 hours in surgery....10,000 times. If a surgeon has done a procedure thousands of times, and he is still doing it...he is not going to put the graft in wrong.
My doc had done over 6000 patella tendon autografts, and refused to to cadaver procedures. He straight up said...it costs him money, but the PTG is a better procedure for active people, and he does not want to short change his patients. If a patient is not athletic, and does not need a patella graft...he will send them to a different doc who speciallizes in allografts.
The Dr. who found the new ligament (ALL or pivot shift) wich is also torn in my knee.
I did beat my meniscus up also not torn but definitely pulled / stretched out
I've discussed my options he's reaction was simple anything less than a Patella tendon graft was no good for the potentially high risk sports and work i did.
That Dr operates almost every mx athlete in the gp's with an knee injury and even Dean wilson has come here more than once to replace his ACL
PB43
Listen to your medical doctor.
Take a look at this site to learn more:
http://www.closerlookatstemcells.org
BTW, I had a complete ACL, MCL and meniscus damage. It took two surgeries and lots of physical therapy and still isn't as good as it was. But, it's 95% functional and isn't a problem on the track. I wouldn't try tennis, though, and it hurts when skiing moguls.
If patients want one particular procedure over another for whatever reason they should seek out what they feel is the "best" for them. All of these grafts can fail and non of them are as strong as the original.
Find an orthopedic surgeon who has a fellowship in sports medicine and see what they have to say. If you don't like their reasoning or thought process get a second opinion. Try and limit how much advice you get from the non-physicians, PT's, etc on here that speak as if their opinion is the gospel.
(-- Actual doctor who sees lots of ACL injuries.
Pit Row
"Rehabilitation Program for Both Knees When the Contralateral Autogenous Patellar Tendon Graft is Used for Primary ACL Reconstruction: A Case Study"
Recoveries that fast..or even faster... are possible with traditional techniques if the patient is willing and able to do high level rehab (most are not...I thought I was...but no way. Who has that much time to do rehab 5 times a day?).
On that paper, Don Shelbourne was one of the surgeons and authors. This was an D-1 level basketball player, who using Shelbourne's Contra-Lateral Patella Tendon Autograft came back faster than than 4 months. So your conclusion that stem cells were responsible for the quick recovery is questionable. A recovery that fast is possible with traditional surgery.
Again, read the some Medical studies. The facts are out there. You are dealing with the marginal percentages. All the techniques can work...but the ratio of failures of one technique to another can be startling. Whatever procedure you feel is best for you...go out and find a doc who is good at that procedure. Never settle on a doc who does procedure A, and then have him do procedure B on your when he rarely does that procedure.
My shoulder was dislocation(7times) and I kept saying, "after the next one, I'm getting this fixed". I wish I just did it after the 2nd time which was 2 years ago.
One thing to note, with health care these days, you can get the best coverage now before your surgey and they will still cover pre existing injures because of the new Obama health laws.
also ask around and get a surgery that knows what you do and what you want to in the future. A sports guy, I was lucky to get in with the guy who works with the Red Bull athletes in Santa Monica.
Thanks, kzizok. I just got back from France where I was invited to give a talk on my lab's work. I am pretty sure I am the only guy in the field that would go to Paris and look longingly at Bercy on the map. I should have postponed the trip until the time was right!
No crash,going thru muddy whoops I get outa shape,dab my foot,it sticks in the mud and stays,pop,swinging by the skin.
What followed was a gruesome few minutes trying to get back to the truck.
Had the patella donor for the acl,staples in the others,a 14 inch incision down my leg.
8 months till walking.
I had the hamstring auto graft. I asked my surgeon about Patella auto graft and or cadaver...he said he payed for his house and sent his kids to college on all the re-do's he did on cadaver graft patients that sought him to fix. As for the Patella he said he quit doing them in the 90's, respected the Patella tendon too much to essentially destroy it, and it won't grow back. Hamstring will grow back.
The downer on the hammy is it takes a long time to get the strength back. Mine was right leg, the transition from brake to peg was tough for many years, wearing knee braces with the straps binding - that last little bit takes some effort. Granted I never did much to increase strength in the gym specifically for hammy.
My knee is incredibly stable, feels tighter than rusted lug nuts on a '55 Chevy. That was 6 years ago and plenty of pounding on the dirt bike since.
I have heard the cadaver grafts have gotten better, better methods to clean the dead person bio out without weakening them. Dunno...anyone?
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