Ligament tear......Terrible Triad

[Deepa]

I was playing tennis and I twisted my leg and tore my ACL, MCL and the meniscus .Thats what we call a "Terrible Triad". I am supposed to have arthroscopy done and get my ACL reconstruted. I was wondering about the drawbacks of an Allograft versus Autograft(From patellar tendon).

Till someone out there replies to my post, I am gonna sit back and relax.(Not that I have doin anythin else for the past 30 days)

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[Mr. happy clown guy]

As a former PT, there are tremendous values found in the allograft achilles tendon repair model.
It certainly speeds healing, and the risk of petella tendon rupture or petello-femoral pain syndrome/tendonitis is GONE!
I have seen absolutely great results from the allograft repairs. With that option now available, I personally would choose that over the petellar tendon autograft repair any day!

 

[iowaboy]

OUCH!!!! I'm sorry about that!!! Thats gotta hurt <img border="0" title="" alt="[Eek!]" src="eek.gif" />

 

[Deepa]

Iowaboy.. It sure does hurtt .I feel so badd that I hav to go through all this
Well anyways... <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> .

Happy clown guy..Thanks for ur reply.
First of all I must say Physiotherapy is amazingg.Before I went to PT I had 0 degrees flexion of my knee.Now after a few visits..I have 65 degrees flexion.I am waiting to reach my full range of motion so that I can have my surgery done. I hav heard that most people hav pain over the anterior of the knee when they hav patellar graft done. <img border="0" title="" alt="[Eek!]" src="eek.gif" />
Moreover I am scared about the Allograft.I guess I am afraid of any Hypersensitive reactions I might get or something like it. .

Autograft or Allograft.. keep em cominggg guys.

 

[iowaboy]

Here's a story that might perk you up...see at least you have a legitimate excuse for your injury, playing tennis. HOWEVER, I do know someone from my med school class who during a pharmacology lecture did something similar!! <img border="0" title="" alt="[Eek!]" src="eek.gif" />

You see.. one day in pharm, the prof. forgot to show up, so these two guys in class thought to pass the time they would get up on the lecture stage and demonstrate to the class how to do a swing dance flip move. Well the one guy flipped the other guy over and ended up doing a terrible triad as well!!

Even though we felt REALLY bad for him <img border="0" alt="[Pity]" title="" src="graemlins/pity.gif" />

It was still the most amusing thing i have ever witnessed in med school!!! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" /> <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

 

[Cassidy61]

while allograft has the benefit of speedier recovery and less patellofemoral pain, its rerupture rate is higher than autograft. autograft has the advantage of solid purchase in both the femoral and tibial tunnel because of the bone blocks at either end and the interference screw, while patellar tendon only has one end with a bone block. this issue of block incorporation and whether it is really superior is a touchy one though.

if it were me and i was concerned about patellofemoral pain, i would have a hamstring tendon autograft. this one is arguably the most physiologic scaffold for rebuilding and has a higher tensile strength.

but, since a bunch of my friends have had acls done and none of them have had long term patellofemoral pain, i would probably go with the patellar tendon autograft. also, i guarantee you that the surgeon performing the procedure has done more patellar-btb grafts than any other!! always go with the high volume option!

and, if you don't want to listen to me at all, go pick up the review article that freddy fu did last year in the american journal of sports medicine on acl reconstruction!

 

[EMDrMoe]

Well said, Cassidy. While I was busy typing, you had it covered

Were you given the option of a hamstring autograft? It would depend on your weight, activity level, etc. Be sure the surgeon has extensive experience with NEW hamstring tendon grafts.

You would avoid the allograft problems (laxity after irradiation, or disease transmission without irradiation) and avoid the patellofemoral pain with a bone-tendon-bone autograft. A number of my patients have had debilitating patellofemoral symptoms.

PS- Don't sit around for 30 days, keep up with the PT

 

[PTjay]

I'm sorry to hear about your injury but would like to comment. I am currently in PT school and a good friend of mine tore her ACL recently. She is 6 wks S/P ACL reconstruction and she had the middle 1/3 of her patellar tendon used for the graft. The Orthopods commonly use the hamstring tendon as well. She opted for the patellar tendon as her doc has had the greatest success with it and did she also did a lot of research on it. Work hard in PT and you will be happy.

 

[aalber9]

Hey, man i know what your going through, I play football and have had my ACL reconstructed twice. The first time with meniscus damage and the second time without. The first time i used the patella graft and the hamstring graft the second. I would without a doubt recomend the hamstring graft. The pain was much less with the hamstring then the patella, I had complete range of motion in 4 weeks compared to about 8 with the patella graft. The only drawback is the therapy is a little more conservative with the hammstring instead of the patella, at first about 12 weeks. If you got any questions email me at [email protected] and I'll answer any questions you have.

p.s
make sure you let a doc who works with athletes do the surgery.

 

[Freeeedom!]

From what I have seen in the recent issues of the "Journal of Sports Medicine" and from personal experience in orthopedics, the Achilles Tendon allograph is the way to go.
I have seen problems with Semitendinosis Grafts (one a fellow medstudent) and one when I was a PT.
Petellar tendon grafts are great, and have a TON of research on them (Primarily from Dr. Shelbourne from Methodist Sports Medicine in Indianapolis, IN)...but I have seen the bad outcomes as well!

I have been absolutely impressed with the allograph recovery time, and decreased INVASIVENESS of the surgery. Remember this is allograph Achilles Tendon , and not allograph patellar tendon grafts.

Once again, if it were me I would NOT do semitendinosis (not a chance in hell), and I would lean toward achilles tendon allograph because of decreased PFjoint problems (though rare, they are there for LIFE when you have it) and decreased invasiveness.
thanks