The Facts before Surgery

On June 2, 2009 I hurt my knee. I was stepping on a ledge and sort of slipped/fell backwards while trying to catch myself from falling. I felt a massive pop on the way down and another on the way up. It hurt like mad for about 3 minutes then was just sore. Then I fell... twice! Yup, without notice or anything; one second I was stepping the next second I was on the ground. This is not good. My knee swelled up to the point that the knee cap was unidentifiable and it would bulge on the top inside and the lower outside of my knee when I bent it. I had full range of motion.

Since I did this on the job it is workers' comp so that means I had to see the clinic doctor. He's a nice guy, but an idiot. I didn't see this doc until June 5 after doing a desk job and the swelling still wasn't gone. I was diagnosed with a "sprain of an unspecified site of knee and leg". Sooo, in other words he didn't know or just didn't want to say in case I decided I felt fine and it never slipped again and therefore it could assumed that I did this at some other time in my life and not at work; yup, I know how it works. After treating for the required 10 days with the clinic doc, who remained "clueless" as to why my knee was instable, I was able to go see my own doc. I went back to see Dr Anderson on June 22 because he is now "my ortho guy" since I've had my elbow and 3 knee incidents treated with him.

Dr. Anderson grabbed my knee and did one of those push pull tests while manipulating my leg just so and I immediately felt some wonkiness. "What did you do? You tore your ACL!" he proclaimed. Oh that's not good! He sent me for an MRI.

The MRI Impression: "A normal anterior cruciate ligament is not identified and appears to be chronically torn. There is a chronic tear of the posterior horn of the medial meniscus which may have been partially resected and there is a small tear in the articular cartilage of the posterior medial femoral condyle. There is a moderate size joint effusion.

Meaning of the Impression: The ACL is completely torn. I tore my meniscus again. And I tore some cartilage covering the knobby part of my lower femur. The ACL is a ligament inside the knee. The meniscus is sandwiched between the joints of your knee. Joint effusion is swelling within the knee. Condyle is the knobby protrusions at the ends of bones.

Injury - June 2, 2009
Clinic - June 5
Clinic - June 8
Clinic - June 11
Dr. Anderson June 22
MRI - July 7
Revisit Dr Anderson for MRI results - July 15
Schedule surgery - August 18
Physical Therapy to begin August 25
Post-Op follow up to be August 26

Surgery Plans: Dr Anderson will drill a hole through where my ACL was and thread in a new ligament. He'll do a partial meniscopy (again) to the torn meniscus. And I totally forgot to ask him about the torn condyle thingy but he'll address it when he's in there.

Ligament Options: There are several options on where this ligament comes from. First off there's an autograft which involves the medical grafting of bone or tissue from the patient's body then there's an allograft where the use of bone or tissue from a donor's (typically a cadaver's) body. I'm having a gracilis allograft. Here's some more specific information on the types of grafts.

Patellar Tendon Graft - The patellar tendon connects the patella (kneecap) to the tibia (shin). The graft is taken from the injured knee. The middle third of the tendon is used, with bone fragments removed on each end. The graft is then threaded through holes drilled in the tibia and femur, and finally screwed into place. The disadvantages of using this graft include: 1. Increased wound pain. 2. Increased scar formation as compared to a hamstring tendon operation. 3. Risk of fracturing the patella during harvesting of the graft. 4. Increased risk of tendinitis. 5. Increased levels of pain with activities that require kneeling years after post op.

Hamstring autografts are made with the semitendinosus tendon either alone, or accompanied by the gracilis tendon for a stronger graft then threaded through the heads of tibia and femur and its ends fixated with screws on the opposite sides of the two bones. A brace is often used to immobilize the knee for one to two weeks to help eliminate motion to the hamstring tendon's fixation to the bone in the post-operative phase. Evidence suggests that the hamstring tendon graft does just as well, or nearly as well, as the patellar tendon graft in the long-term.
The main surgical wound is over the upper proximal tibia, avoiding the typical pain sensation when one kneels down. The wound is typically smaller than the patellar tendon graft and hence less pain after the operation. There seems to be some controversy as to how well hamstring tendon regenerates after the harvesting. Most studies suggest that the tendon can be regenerated at least partially, while still being inferior in strength to the original tendon.

I chose the allograft because 1) I don't need any more problems as associated with patellar tendon graft. 2) That hamstring was torn a few years ago and needs all the ligaments possible. 3) It's less invasive which means quicker recovery 4) After 3 months the recovery playing field for all grafts mentioned are equal 4) Dr Anderson recommended it and how can I argue with a superb surgeon and a past patient of this procedure himself.