ACL surgery

Just wondering if anyone is familiar with a newish surgery they are doing. At least in Australia anyway. 

Using bone graft to assist and not hamstrings. 

Apparently it is a little quicker and more reliable. I had one years ago with the hamstrings and now my son just had one and it surprised me what they did. Seems to be harder in the short term, but better in the long term. 

 

"An ACL surgery bone graft, most commonly a bone-patellar tendon-bone (BPTCool graft, is a surgical procedure to reconstruct a torn anterior cruciate ligament using a section of the patient's own patellar tendon, which includes a bone plug from the kneecap and a bone plug from the shin bone. This type of graft is favored for active individuals because the bone-to-bone healing is strong and promotes good long-term stability and function in the knee"

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Rotaholic
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10/13/2025 11:16pm

I had that done in New Zealand in 2010, no complaints here, super strong and as good as new. I cant straighten the leg as much as before but its so close to straight it doesn't matter.

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Bearuno
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10/13/2025 11:17pm Edited Date/Time 10/14/2025 2:38am

The 'Bone - Patellar Tendon - Bone' type of repair has been around for decades.

I'll have to check it out, to see if it is actually substantially different to what I had done, several decades ago. Perhaps it is - things Do change.

I think that was my first ( well, actually, the second - first was just reattaching the 'plug' of bone ripped out by the ACL) 'add on' reconstruction done, in the 70s. Then Hamstring, Cadaver donation, Zenograft, Carbon Fiber, Gortex, Ligastic. A couple of those, a couple of times - Both knees, other than the B-PT-B on my LH knee, as I 'lost' my kneecap in '81, and Drs thought it was a No Go on weakening the remnant Patellar Tendon. 

Nothing ever lasted long, but, then again, I never wrapped myself up in cotton wool. I kept at 'it'. CTIs certainly helped.

 

PS : at some stage over the years, my PCLs 'disappeared' / went AWOL, too............... 😒

2
10/13/2025 11:25pm

Semi unrelated: I've snapped them in both knees and never had surgery. Some people dont need them intact if you build up the muscles around the knee.

- after the initial trauma dies down the body can adapt pretty good. I long distance thru hike with them. "Knees over toes guy" on youtube has all sorts of great exercises to make them robust

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1
10/14/2025 1:52am
motokiwi wrote:
Semi unrelated: I've snapped them in both knees and never had surgery. Some people dont need them intact if you build up the muscles around the...

Semi unrelated: I've snapped them in both knees and never had surgery. Some people dont need them intact if you build up the muscles around the knee.

- after the initial trauma dies down the body can adapt pretty good. I long distance thru hike with them. "Knees over toes guy" on youtube has all sorts of great exercises to make them robust

Yeah I did a season with it gone. Not even sure why I got it done, looking back now. Still now subconscious is thinking about stepping correctly up and down stairs

The Shop

10/14/2025 3:03am

We spoke about it but eventually had an ACL donor graft (allograft) done last year. 
My second reco on the same knee. Had hamstring graft first time round. I bloody feel pretty much back to normal at nearly 50 so no complaints. 
Something else to consider and just my 2c worth

gscx
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10/14/2025 6:11am

Not getting an ACL repaired seems OK at first but in the end it is going to cause damage and arthritis in the knee. Especially for active individuals. I got mine repaired a month after tearing and I was lifting almost as much as before injury. But when dead lifting heavy I could feel my femur sliding forward a bit. Its 8 months of suck after the surgery but worth it. When people try to come back too quick is when there are problems with it.

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GrapeApe
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10/14/2025 6:30am

My daughter had the patellar graft 3 months ago. We also discussed quad and hamstring grafts but for a young athlete the patellar graft was the best option. She has been doing PT 2-3 times a week and just started jogging on a treadmill this week.     

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beamer
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10/14/2025 7:10am

My son as had 2 x patella tendon implants, first graft came from the upper tendon and the second from the lower. 

avidchimp
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10/14/2025 7:21am
gscx wrote:
Not getting an ACL repaired seems OK at first but in the end it is going to cause damage and arthritis in the knee. Especially for...

Not getting an ACL repaired seems OK at first but in the end it is going to cause damage and arthritis in the knee. Especially for active individuals. I got mine repaired a month after tearing and I was lifting almost as much as before injury. But when dead lifting heavy I could feel my femur sliding forward a bit. Its 8 months of suck after the surgery but worth it. When people try to come back too quick is when there are problems with it.

I literally went to my Ortho yesterday to get my right knee looked at. I lost the right acl 25 years ago and have been running it without one for all this time. Had my left acl fixed a year and a half before I blew out the right one with a patella graft and haven't had any issues since. 

My MRI is scheduled for this Sunday at 7:30am, but just going off the x-ray's we did yesterday my left knee has far more arthritis buildup than my right, and both are pretty much bone on bone at this point. I'm 52 and other than when I OJ something pretty bad, I am pretty much pain free doing most things I like to do.

All that said, the patella graft is the best way to go.

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Ob917
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10/14/2025 7:30am

I had a patella graft done years ago. Shitty surgery, I skipped surgery on my other knee. 

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RDnutz
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10/14/2025 8:11am

my wife was offered something similar earlier this year and I was shocked hearing about it as my ACL reconstruction 25 years ago was way more involved and time consuming with longer recovery. I went with her on follow up to hear more about the newer procedure- but she opted for PT instead and bailed on surgery.

 

What did Jett have? he came back really quick from his.

kijen
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10/14/2025 8:53am

Ive read the patella tendon graft is preferred for athletes, as the hamstring graft has negative impact for athletes. The downside is the patella can be very tender when kneeling directly on the knee, upside is return to the sport faster.

SoCalMX70
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10/14/2025 12:43pm

That type of graft is literally the "gold standard". Been around a long time. Yes, recovery is a bit more difficult, but has great long term outcomes.

mikelawlor
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10/14/2025 5:35pm

I kneel a lot for work so the dr told me do hamstring. Patella you have a huge scar down the front of your knee and if you kneel on it it hurts. Also they told me the hamstring regenerates. I’m 9 years on my hamstring acl and it feels no different than the other knee. Just make sure he goes to a good PT to get the range of motion back. That makes a big difference. 

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WhipMeister
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10/14/2025 6:25pm

Patella graft in 1995. Tried to power through at first with no surgery. But that one took a hit in practice that convinced me I had to do it. It was like I had re-injured it all over again. Everything went great. I was cleared to ride again 90 days post-op. 

Tore my other knee up in 2009. Have not had it repaired. Have not caught it in the same 'just right' way with bone-on-bone (worst soul-crushing pain ever!).  Made it through a hard enduro loop in Kauai last month without serious complication though I did tweak it on one of my dozen or so off-bike excursions. And I'm an old fart.

10/14/2025 6:40pm

Interesting. I was never offered the Patella one. With the Hamstring one, I literally walked out of hospital and drove my manual Ute home. Stretching straight all the time would be painful. However the patella one seems to be more painful up front. My son maybe just has less pain tolerance. But it does seem like it is alot harder short term. It is 3 weeks now and he is walking with out crutches. 

The surgeon said quicker turn around. I have no idea how Jett did what he did. Such a small turn around and not worried about weakness and reinjuring. I was talking with a physio about it and he named a few olympic athletes who did pretty similar. I guess more access to more specialists

Braaaphole
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10/14/2025 7:14pm

My son had the patella graft done back in January. He's been doing PT twice a week for months. He has full range of motion, but it's taking a while to get the strength back in that leg. He's still not fully released from the Dr, but they did release him to get back on the bike a few weeks ago. He's having a hard time mentally getting past it and riding like he knows how. He doesn't trust the knee yet and he's scared of hurting it again. 

I know there's another Dr that's doing the patella graft and wrapping it somehow. Some of the pro riders are going to him and he's getting them back on the bike a lot faster. Seems very risky but maybe it is working because they are professional athletes with a lot of muscle and strength in the leg already.

brocster
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10/14/2025 7:38pm

Had a patellar graft done in 1996.  Still kickin like a chicken. 

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mxaniac
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10/14/2025 8:30pm

I always had allografts from cadavers. Surgeon said I did so much damage I didn't leave anything harvestable both times.

But in reading up in it, sounds like higher risk of arthritis with bone grafts. Actually I read 100% chance of arthritis after 17 years. It's still 71% with the hamstring though. 

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cwtoyota
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10/15/2025 8:58am

If your patella is in good shape, the patellar tendon graft is a good option.  
My doc (a sports medicine guy) told me that with a very arthritic patella, it's better to go with the cadaver graft.

I'm in full agreement with @gscx  about getting the ACL reconstructed.  
Without the ACL intact, you put more stress on the meniscus, cartilage and other ligaments.

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WhipMeister
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10/15/2025 2:00pm
mxaniac wrote:
I always had allografts from cadavers. Surgeon said I did so much damage I didn't leave anything harvestable both times.But in reading up in it, sounds...

I always had allografts from cadavers. Surgeon said I did so much damage I didn't leave anything harvestable both times.

But in reading up in it, sounds like higher risk of arthritis with bone grafts. Actually I read 100% chance of arthritis after 17 years. It's still 71% with the hamstring though. 

I'm going on 30 years (f**k !!!) with my left knee patellar graft. No signs of arthritis, though it has loosened up a little over time. 15 years into the right knee ACL tear, which was worse than the left, with no surgery. But I have to be careful with that one.

1
mxaniac
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10/15/2025 4:19pm
mxaniac wrote:
I always had allografts from cadavers. Surgeon said I did so much damage I didn't leave anything harvestable both times.But in reading up in it, sounds...

I always had allografts from cadavers. Surgeon said I did so much damage I didn't leave anything harvestable both times.

But in reading up in it, sounds like higher risk of arthritis with bone grafts. Actually I read 100% chance of arthritis after 17 years. It's still 71% with the hamstring though. 

I'm going on 30 years (f**k !!!) with my left knee patellar graft. No signs of arthritis, though it has loosened up a little over time...

I'm going on 30 years (f**k !!!) with my left knee patellar graft. No signs of arthritis, though it has loosened up a little over time. 15 years into the right knee ACL tear, which was worse than the left, with no surgery. But I have to be careful with that one.

2005 cadaver allograft on my left, 2012 on my right. Damn we're old.

10/15/2025 9:58pm
Braaaphole wrote:
My son had the patella graft done back in January. He's been doing PT twice a week for months. He has full range of motion, but...

My son had the patella graft done back in January. He's been doing PT twice a week for months. He has full range of motion, but it's taking a while to get the strength back in that leg. He's still not fully released from the Dr, but they did release him to get back on the bike a few weeks ago. He's having a hard time mentally getting past it and riding like he knows how. He doesn't trust the knee yet and he's scared of hurting it again. 

I know there's another Dr that's doing the patella graft and wrapping it somehow. Some of the pro riders are going to him and he's getting them back on the bike a lot faster. Seems very risky but maybe it is working because they are professional athletes with a lot of muscle and strength in the leg already.

Its funny you say that. That is my biggest fear, is the mental effect. Its alot on the brain for a long time. Its unfortunate the window in this sport is so small. Hard to have time for an AC injury unless your already a factory rider. 

I think it will be a long time until confidence comes back. We are hoping to do what races are possible coming back next year in Australia. Than try go to a facility in US for a couple months to just boot camp and ride it all away

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