What Graft is Best for a Torn ACL? | ACL Surgeon | Dr. Bill Sterett
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- Опубликовано: 5 окт 2024
- drsterett.com/
In this Sports Medicine Minute video, Dr. Bill Sterett answers the question, "What is the best graft for a torn ACL?. Dr. Sterett is a sports medicine doctor with a special focus in ACL tears at Vail-Summit Orthopaedics & Neurosurgery.
With a torn ACL, it is best to replace the torn ligament with a new graft. Less than 10% of the time is the ACL repaired. 90% of the time the torn ACL is removed, and replaced with a new graft. There are four different choices:
1. Cadaver graft
2. Middle of the patellar tendon
3. Middle of the quad tendon
4. Hamstring tendon
Cadaver graft for patient's age 20 and below have shown a much higher rate of re-tearing. Studies have shown a 30% re-tear rate within the first year for cadaver grafts in the younger age demographic. Over age 40, a cadaver graft is a viable choice.
Using your own Tissue
The patellar tendon graft has been the most commonly used graft since the 80s. It is now only used 50% of the time due to advancements in surgical techniques and technology. A patellar graft has a lower rate of re-rupture, but a higher rate of arthritis in the knee down the road.
The hamstring graft is a great choice, but if you are loose jointed, and hyperextend your knee often then you should avoid using the hamstring graft. Females are more likely to be loose jointed compared to the male counterpart, so the hamstring graft is not as commonly used in female patients.
The quad graft is a great choice. It eliminates the risk of patellar tendonitis, and also has a lower risk for arthritis down the road.
All of the graft choices have their purpose. To learn more about ACL graft choices, please visit: drsterett.com/...
I had ACL surgery and bucket-handle tear in my meniscus. Surgeon tried to reattach the bucket-handle but it didn't hold so he had to remove the torn part. But due to removal, it meant that I was able to walk right away. The graft I opted with was hamstring graft since I had heard about the issues with patellar tendon and life-long ghost pain in your knee or while being on top of your knees. There are some positions (walking stairs or raising you leg while knee is bent) where I can feel the area clearly from where the graft was taken but in normal walking that's not an issue. Overall I think the healing is progressing pretty nicely and don't regret going with hamstring graft.
2 months update: There hasn't been any issues with the hamstring craft I opted. The main cut has healed well, the original feeling of pain when rotating knee has pretty much disappeared. Main issues have been the regular ACL stuff (extending and bending your knee) and loss of some muscle mass from the thigh. Leg extension is pretty smooth now although lacking some hyper extension, bending the knee has also gotten better although it's only 125 degree according to physiotherapist. Have been doing mostly the common ACL rehab movements, lightweight gym training (e.g. leg extensions) as well as flexibility exercises. Nothing still prevents me from living normal live, like walking stairs, cycling or even doing leg exercises at a gym. As long as I don't do anything rash, e.g deep squats or load very heavy sets then everything is fine, and can do just fine things like Romanian deadlifts, leg presses, one leg squats, etc. Looking forward for the 3rd and 4th month when I can finally start also jogging.
Overall I'm very positive about my healing process and thought it would be much more troublesome and painful based on the things I knew pre-injury and heard from others related to ACL. Sure, healing and rehab takes time but I consider it's a short time and price to pay for it as long as I get back to full health. Just recommend everyone to be patient and follow rehab instructions!
My surgeon suggested quadriceps graft because hamstring graft could cause more instability issues in my knee. I have multiple damaged ligaments so anything that affects stability is a no go. His reason for choosing quad over patella was that patella can give more problems with pain and a larger scar. Tho quad graft makes the rehab slower initially, it seems the best for me in the long run. This video gave me insight into the different grafts and makes me confident we picked the best option, thanks!
This is a fantastic video and reinforced my choice of my quad graft I have surgery may 14th!
Good luck, I hope everything goes well. I’m going to speak with my surgeon tmr & the quad graft is looking as my top choice as well
@@y.h_3 thank you good luck to you too!
I have a complete acl tear that qualifies for a repair because it is so high, but I opted for a full reconstruction because I’m a motocross racer and hiker. The surgeon I saw last week was going to do a BTB graft, but my new surgeon is recommending a quadriceps graft. My surgery is Wednesday. The reason for the change of surgeons is because I have a bucket handle tear on my meniscus and it’s time sensitive. I’m nervous and I’m hoping the quadricep grafts gives me a chance at a full return to sports in a year or so.
I had a hamstring graft, lasted me 9 almost 10 years. Just re tore it recently, my doctor wants to do a btb graft. I want an internal brace, have read good things about it
How are u feeling bro
im convincing myself of getting a cadaver graft :), great info thank you
How much trust we can have on cadaver graph sterilization i mean how to make sure the donor doesn’t have any major health and disease.
Very informative🙌🏼
Do peroneus longus!!
Please make a video on peroneus longus.
which tendon is best for sternoclavicular joint reconstruction after sc dislocation and how to prevent re rupture after sc joint stabilisation surgery thnkas....
i have ac shoulder joints bump but no pain lol
why is there less rupture for 40 year olds getting an autograft vs younger? Does it have to do with activity levels or something else? If a 40 year old is highly active would you recommend an autograft or allograft?
Because 40 year olds aren’t as active as younger people 40 year olds aren’t typically running around like a 20 year old is
Thank you so much 🙏
do hamstring/ patellar grafts not grow back or repair after you remove them?
I believe your harvested hamstring will re-balance itself up to 95% after 1.5 to 2 years. But a little loss of power would be noticable in early stages
Fantastic video! What is the optimal time to bend the knee? I am in the 3rd month after the injury and can bend at the time 90 angle . I haven’t had surgery yet, and I have a complete rupture. Is this a critical problem later?
Need recommendation. I’m 31. Years old . 215 pounds Going four years on ACL tear / meniscus tear i have rehabbed knee through PT. Still torn on new MRI . I am a month out from getting a surgery doc recommends patella. Currently I am able to still squat run jump rope yet unstable left to right and a small twist can take me out for a couple days.
How common is the BEAR graft? And is the recovery slower or faster than a normal ACL repair.
My daughter has just torn her ACL, MCL, and meniscus, maybe more. She is 25. I live 1000 miles away but want to go and help her. Roughly, how long will it be before she can be independent enough to be on her own? Left knee. Thanks
I had exactly the same what your daughter has. Just had my surgery ACL reconstruction and a meniscus root repair. MCL needs to heal first before surgery. It took me 4 months to have my MCL and LCL to heal by itself. In those 4 months I managed to be independent after the first 2 months until surgery.
Currently in my 7th week of fysio. Post surgery she probably needs help the first 4 to 5 months, before she can be independent.
Doctor may i ask is What is loose joint?
Dr steve jobs
The best is your own tendons
Thanks gangster
who's had quad graft done?
Me
@@rfabian10 any knee pain or "side effect"?
I tore it in trining while grappling on the 19 of march and had surgery the 29th (so 2 days ago). I m in my mid 20's, male and non loose jointed in my case they used hamstrings tendons. 2 days after surgery i can srand on it but i can t walk
wow, howd you get in so fast?
@@danielnillo i m young It usually helps with faster recoveries, but the First 2 weeks have been very painful. Currently i can walk drive and do everything, except sports obviously.
How are you doing now? I have surgery in the first week of June and I will be having a hamstring graft. I am scared as well.