Anyone here had a total ACL replacement/transplant, not "just" a rebuild? Any advice or regrets? Rich, are you aware of any evidence-based medical research into this?
Both of my knees have been without anterior cruciate ligaments for nearly six years, although I didn't get it diagnosed until July 2006. I've continued to do tae kwon do and heavy yardwork with custom-fit orthopedic braces for over a year. I've recovered from multiple sprains of the remaining ligaments, my full-squat flexibility is back, and my knees are stronger than ever. I feel occasional pain from damage to each medial meniscus and the knees stiffen up after 30 minutes of sitting but there's no more swelling and I've been ibuprofen-free for over a month. I'm two steps (and about 18 months away) from my black belt. Life seems pretty good and I expected to avoid surgery indefinitely.
One of the reasons I chose braces over surgery last year was reading & hearing many reports about lackluster results of rebuilding ACLs. After six years I'm not sure how much ACL I have left to work with and the crusty ol' orthopedic surgeon was reluctant to operate. With all the patience & bedside manner of a Marine drill sergeant, he expressed the opinion that he didn't want to "waste his time" rebuilding my ACLs if I was just going to keep doing martial arts. Well, fine, then, no surgery for me.
Over the last two months, though, I've had a problem with my right knee (the "good" one) four times. Each happened after considerable exertion, mostly without braces. The first time was just raising my right leg to step up into the tub-- something in my knee twitched (the way a neck tendon snaps) and suddenly I couldn't extend my right leg or put any weight on it. I thought the pain was coming from the lateral collateral ligament. About two minutes later something snapped back into place and everything was fine-- no problems, no pain. A couple weeks later and a month later the same thing happened with the same results.
The fourth time was last Thursday's dinner when I tried to stand up from my chair. This time, however, things didn't "snap back" into place and I spent the rest of the evening with a bent leg and a bottle (of ibuprofen). The night was uncomfortable and next morning wasn't much better so I got an appointment with the local clinic's duty D.O. Somewhere during his prodding & twisting, the snapback happened and everything was fine again. Whew.
This new doctor, a 30-something surferdude right on my wavelength, says that it's my right lateral meniscus grinding and "locking up" with what's left of the cartilage. He was horrified ("Hey, Dr. Jones, Dr. Smith, you wanna come see this?") by how lax & flexible my knee joints are. He agrees that martial arts can be a risk, but he thinks that my knees are so floppy that I'm taking a far greater risk just walking around... and randomly grinding my remaining cartilage on my frayed meniscii. Orthopedic braces are "safer" but they're two pounds each of neoprene & carbon fiber & Velcro straps-- way too hot to wear 24/7.
Luckily wearing the braces full time isn't a good idea either because knees atrophy quickly (patients actually get psychologically addicted to braces). Squats & surfing and even controlled martial arts will keep my knees strong but his opinion is that their laxity makes them a ticking time bomb. He wouldn't pick a definite number but he says that the crepitation is bad, osteoarthritis has already started, and I should be in constant pain. In 15-25 years I'll be facing two total knee replacements, maybe sooner if I keep having these "incidents".
Aside from wearing braces more frequently for exertion (all yardwork & honey-dos) he recommended ACL transplants. One source is a long, thin slice of your patellar tendon and another source is cadavers. (As you can imagine, each source has its issues.) The "operation" pretty much drills out & taps the femur & tibia, screws in the tendon, and glues it down-- perhaps with a little hardware to hold things in place. It's all done arthroscopically. A mere 6-12 months (each knee) later you're back on the road to recovery.
This isn't the kind of surgery where you fly to the Mayo Clinic or Hopkins and a week later fly home. Unfortunately this morning I read that there are only 48 orthopedic surgeons in the entire state and I've already crossed one of them off my list. No offense intended to the rest but the remaining talent pool might be kinda shallow.
So during the next month I'll have another MRI at [-]Crippler[/-] Tripler Army Medical Center and consult with another randomly-assigned orthopedic surgeon. I'm in no hurry and I'm hoping to hold off at least three more years until our kid's in college and we're empty-nesters. That'll give me plenty of time to [-]work through the five stages[/-] research the options and maybe even choose a rock-star orthopod.
Spouse has pointed out that if I'm going to be immobilized then it might be worth [-]vacationing at[/-] going to Bumrungrad. I wouldn't mind visiting there just to pay for a good set of MRIs, X-rays, and whatever other imagery they want [-]me to pay for[/-] to do. It'd make a heckuva second opinion.
Any other ideas? Anything else I should be researching?
Both of my knees have been without anterior cruciate ligaments for nearly six years, although I didn't get it diagnosed until July 2006. I've continued to do tae kwon do and heavy yardwork with custom-fit orthopedic braces for over a year. I've recovered from multiple sprains of the remaining ligaments, my full-squat flexibility is back, and my knees are stronger than ever. I feel occasional pain from damage to each medial meniscus and the knees stiffen up after 30 minutes of sitting but there's no more swelling and I've been ibuprofen-free for over a month. I'm two steps (and about 18 months away) from my black belt. Life seems pretty good and I expected to avoid surgery indefinitely.
One of the reasons I chose braces over surgery last year was reading & hearing many reports about lackluster results of rebuilding ACLs. After six years I'm not sure how much ACL I have left to work with and the crusty ol' orthopedic surgeon was reluctant to operate. With all the patience & bedside manner of a Marine drill sergeant, he expressed the opinion that he didn't want to "waste his time" rebuilding my ACLs if I was just going to keep doing martial arts. Well, fine, then, no surgery for me.
Over the last two months, though, I've had a problem with my right knee (the "good" one) four times. Each happened after considerable exertion, mostly without braces. The first time was just raising my right leg to step up into the tub-- something in my knee twitched (the way a neck tendon snaps) and suddenly I couldn't extend my right leg or put any weight on it. I thought the pain was coming from the lateral collateral ligament. About two minutes later something snapped back into place and everything was fine-- no problems, no pain. A couple weeks later and a month later the same thing happened with the same results.
The fourth time was last Thursday's dinner when I tried to stand up from my chair. This time, however, things didn't "snap back" into place and I spent the rest of the evening with a bent leg and a bottle (of ibuprofen). The night was uncomfortable and next morning wasn't much better so I got an appointment with the local clinic's duty D.O. Somewhere during his prodding & twisting, the snapback happened and everything was fine again. Whew.
This new doctor, a 30-something surferdude right on my wavelength, says that it's my right lateral meniscus grinding and "locking up" with what's left of the cartilage. He was horrified ("Hey, Dr. Jones, Dr. Smith, you wanna come see this?") by how lax & flexible my knee joints are. He agrees that martial arts can be a risk, but he thinks that my knees are so floppy that I'm taking a far greater risk just walking around... and randomly grinding my remaining cartilage on my frayed meniscii. Orthopedic braces are "safer" but they're two pounds each of neoprene & carbon fiber & Velcro straps-- way too hot to wear 24/7.
Luckily wearing the braces full time isn't a good idea either because knees atrophy quickly (patients actually get psychologically addicted to braces). Squats & surfing and even controlled martial arts will keep my knees strong but his opinion is that their laxity makes them a ticking time bomb. He wouldn't pick a definite number but he says that the crepitation is bad, osteoarthritis has already started, and I should be in constant pain. In 15-25 years I'll be facing two total knee replacements, maybe sooner if I keep having these "incidents".
Aside from wearing braces more frequently for exertion (all yardwork & honey-dos) he recommended ACL transplants. One source is a long, thin slice of your patellar tendon and another source is cadavers. (As you can imagine, each source has its issues.) The "operation" pretty much drills out & taps the femur & tibia, screws in the tendon, and glues it down-- perhaps with a little hardware to hold things in place. It's all done arthroscopically. A mere 6-12 months (each knee) later you're back on the road to recovery.
This isn't the kind of surgery where you fly to the Mayo Clinic or Hopkins and a week later fly home. Unfortunately this morning I read that there are only 48 orthopedic surgeons in the entire state and I've already crossed one of them off my list. No offense intended to the rest but the remaining talent pool might be kinda shallow.
So during the next month I'll have another MRI at [-]Crippler[/-] Tripler Army Medical Center and consult with another randomly-assigned orthopedic surgeon. I'm in no hurry and I'm hoping to hold off at least three more years until our kid's in college and we're empty-nesters. That'll give me plenty of time to [-]work through the five stages[/-] research the options and maybe even choose a rock-star orthopod.
Spouse has pointed out that if I'm going to be immobilized then it might be worth [-]vacationing at[/-] going to Bumrungrad. I wouldn't mind visiting there just to pay for a good set of MRIs, X-rays, and whatever other imagery they want [-]me to pay for[/-] to do. It'd make a heckuva second opinion.
Any other ideas? Anything else I should be researching?