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ACL Reconstruction

PostPosted: Fri Dec 13, 2019 8:59 am
by oragami_itto
The Anterior Cruciate Ligament (ACL) is one of two ligaments that cross at the knee and attach the tibia to the femur that provide stability to the joint.

Ten years ago I fell victim to a nasty sweep in a BJJ exhibition match and my ACL sheared at the femur. Incidentally, this means that more than 1492 Newtons of force were applied laterally. This left my knee unstable and hypermobile, which led to frequent sprainings and other light injuries during activities such as push hands, or stepping down off a stepstool to change a light bulb. It also had the effect of chewing up a little bit of my meniscus, the cartilaginous cushion between the two bones, over time.

Four weeks ago I had surgery to reconstruct my ACL and remove damaged portions of my meniscus, and frankly I feel fantastic.

I've got almost full range of motion in the affected leg. I can bend and extend fully, but if I were to put the ankle on the opposite knee and then push down on the bent knee, that still hurts, but I can do it with the natural knee just fine. I can kick with it at chin height with power.

This is a little bit amazing to me because I didn't expect to be off of crutches this early, much less kicking and bending and walking without a limp.

And this success comes with not even having started the formal Physical Therapy I've been prescribed, just a tiny bit of taijiquan and walking the dog for exercise.

I can't take all the credit, though, the procedure itself used the latest technology, and we're a far cry away from the days where such a surgery required flaying open the knee to the bone and then keeping it immobilized in a cast for six months, with another six months of grueling physical therapy to wind up with permanently reduced function.

Here's what they did.

To replace this ligament, the usual method is to harvest a length of hamstring from the patient. This results in a bit more pain during a necessarily longer recovery, and a year before "most" of the tendon grows back.

We opted for an allograft. This uses donor tissue from a cadaver. When requesting the tendons from the body bank, my surgeon asked for tendons from someone under 30 who died due to trauma. There's no need for blood typing or other genetic matching. Any old tendon will work.

He harvested two tendons, a bit longer than twice as long as needed, these are then bent double together to produce a bundle about 9mm thick and pulled through a corresponding hole drilled in my tibia and femur with a wire.

Before insertion, the tendons are soaked in stem cells. Once they are in place, a syringe is used to saturate them with Platelet Rich Plasma processed from my own blood. This activates the stem cells and gets them to work growing blood vessels, etc.

The tendons are fixed to the tibia on bottom with a screw that clamps the ends against the sides of the hole, and the opposite side is held in place with a "suture button" that catches the bent middle of the tendons in a loop.

This is all done arthroscopically, so I have five tiny incisions around my knee, a total of ten stitches worth of cuts. Tubes were inserted into the incisions, the surgeon works the camera through one tube and his instruments through another, and to me that's the most impressive part of the whole thing. It's like working on a car engine through the tailpipe. Nuts.

I haven't yet gotten back to daily taijiquan practice, but that's sheer laziness on my part. It'll be at least another two months before the DR clears me for push hands, but I plan to be back in full on obsessive weapons and empty hand form practice by then.

Thanks for coming to my TED talk.


Re: ACL Reconstruction

PostPosted: Fri Dec 13, 2019 9:32 am
by Tom
Great outcome (so far)! Best wishes for continued good healing and restoration of a thousand years of power.

It's quite interesting to learn how the surgical and repair techniques have advanced in the past few years, particularly with respect to the use of stem cells and platelet concentrate to nurture the ligamentous and surrounding tissue. Thanks for sharing the details.

Re: ACL Reconstruction

PostPosted: Fri Dec 13, 2019 10:01 am
by GrahamB
That's pretty darn good for 4 weeks! Have a good recovery.

Re: ACL Reconstruction

PostPosted: Fri Dec 13, 2019 10:06 am
by Peacedog
Good news on the surgery. Sounds like you got a good cutter.

Don't go too crazy for the first few months. I've had a few friends that "undid" some otherwise very successful surgery that way.

Consider taking some Bone Knitting Pills as well to speed up the healing process. Just keep an eye on your blood pressure if you do, it will transitorily raise it in some folks. ... m00015.htm

Otherwise, enjoy your fixed knee. Too many people never get it done and choose to live with it instead. Which given state of the art surgery is a mistake these days.

Re: ACL Reconstruction

PostPosted: Fri Dec 13, 2019 10:43 am
by windwalker
Congratulations on a successful recovery.
I thought I might have injured mine do to an interaction with some guys who practice "sambo" a Russian art a long while back.
Thought I might have tore it during a " friendly" exchange, thinking it was friendly.
He got tossed after. :-\

Couldn't do much with it for close to 6 months.
Didn't want to go to the hospital to get it checked, seemed to heal up
on its own, ya never know :P

Hope and best wishes for your continuing recovery.

Re: ACL Reconstruction

PostPosted: Fri Dec 13, 2019 8:32 pm
by everything
Wow that is fantastic.

One thing I can't follow is how the cadaver tendon helps the ligament. Or did they help you reconstruct tendon?

I thought I tore my medial meniscus after I and another guy both kicked the same soccer ball really hard against each other's force (force on force ugh). I saw a surgeon who said I strained the MCL instead. It gives me some minor pain from time to time. :-\ I doubt I need surgery but it's cool to hear it's getting so darn good. I avoid kicking hard into tackles now.

Re: ACL Reconstruction

PostPosted: Sat Dec 14, 2019 4:57 pm
by oragami_itto
Thanks for the well wishes, everybody. I spent some time going through some exercises today and I'm still not 100%, unsteady with a little pain in some positions, but I expect to be fully recovered very soon.

everything wrote:One thing I can't follow is how the cadaver tendon helps the ligament. Or did they help you reconstruct tendon?

Ligaments and tendons are basically the same kind of tissue, just tendons attach muscle to bone and ligaments attach bone to bone. Since the original ligament was gone, the donor tendon becomes the new ligament.

Re: ACL Reconstruction

PostPosted: Sat Dec 14, 2019 10:29 pm
by everything
damn that is amazing. best wishes in your recovery!