ACL Rupture

Based on my son's ACL - plus what I have learned from others, from the time he has surgery it will be 4-6 months before he will be cleared to play. Another month or two to shake the rust off and rebuild strength.

Be happy to answer any questions via PM

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johnj314, I'm sending you a PM. You'll see a link at the top of your page for you to click in order to receive it..

sorry to hear the news John. Do get the second opinion, even though the diagnosis is pretty simple. Find the best doctor you can, it makes a difference. Possibly someone with the Cards or Rams. Find the best physical therapist you can, this is every bit as important as the surgery. Do everything they say no more no less. My freshman son is 5.5 months post opp. He started running on a treadmill by 3 months. Long toss at 3.5 months. hitting in a cage at 3.5 months. pitching in a game at 4.75 months no fielding. Hitting in a game at 4.75 months with the ability to run full speed through first no turn, doubles etc. He is not cleared to play short stop. Basically anything that requires fast and hard change in direction is not allowed. He will receive full release at 6.5 months. His physical therapist who works with him three days a week was the head athletic trainer at WSU for 25 years. He says if it were up to him he would have released him at 5 months. BE PATIENT. What type of reconstructive surgery are you thinking of?

We got the second opninion today and he confirmed diagnosis of torn ACL and possible meniscus tear. Concerned that he is unable to totally straighten his knee. Will have PT pre-op to get it as straight as possible. Surgery scheduledfor this Friday. Not sure if his Patella is sound enough to use for new ACL graft. If they get in there and can't use the Patella we'll use a cadevar rather than the hammy option. Dr. Rick Lehman is who we are using and he is oneof the best in STL having done many Cards, Blues, Rams, etc...say a prayer for him, Adam Jelovic...

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Concerned that he is unable to totally straighten his knee. Will have PT pre-op to get it as straight as possible. Surgery scheduledfor this Friday.

Good luck. Gonna be a long haul and from the sounds of it, the doctor is not helping the cause. Surgery less than 2 weeks post-injury makes post-op rehab difficult.

Where will he be going for rehab?

best wishes Adam. you will have a greater love for the game and respect for your health. you will know more about patience, perseverance, dedication and hard work making you more successful in everything you do. all will work out!!!! keep us posted.

Bulldog, he tore it on Monday, March 22 so surgery will be like 19 days after he hurt it. Dr. Lehman said that since there is minimal swelling he is taking an aggressive approach to get him back to 100% as quickly and as safely as possible. His main concern is getting the leg completely straight...The PT we are using is Advanced Training and Rehab (www.ATR-STL.com). They are actually in the same building across the hall from Lehman's office (imagine that...) and also have four other locations one being 5 minutes from where we live...

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Our son had the hammy omelette option a month or so ago. He's expected to be at full tilt by August.

Why the thumbs down on the hammy option?

We were led to believe the recovery time was shorter than the patella option.

We're wishing all goes well with your son's surgery and rehab.




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Gotwood4sale- what we were told by Dr. Lehman and confirmed with some Google research is that the hamstring will become a stronger graft than the cadevar, however it takes out 1/3 of the hamstring. They cut it into three strips and braid it together. This will (supposedly) create a loss in strength, power, speed, and quickness with that leg that may never totally recover. We're hoping that the patella is OK and can be used. The risk of the cadevar is that the graft/ repalcement ligament will tear again. Google some of this and see what you think. It's probably six of one and a half dozen the other...The Milwaukee Brewers pitcher, Gallardo, tore his ACL and had the patella option in May 08 and recovered fairly quickly and made a couple cameo's in September 08 including a start in the division playoffs. We're hopefull of a similiar recovery...Good luck with your son's rehab and future athletic endeavors...

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I did some research and followed up with some questions to our son's surgical group.

You are correct that the hamstring (or patella) tendon will not regenerate after surgery. This results in a loss of strength in the tendon.

As I now understand, each leg has three hamstring tendons. One is essential while the other two are less so.

Our son's surgeon harvested pieces of the two tendons which are not as essential. The pieces are then prepped and braided together for strength and then attached to the tibia and femur in an alignment the same as the original ACL.

There are pluses and minuses to all of the options. One of the pluses for the hamstring option is the quicker recovery as compared to the patella option. I'm not sure how the hamstring option compares to the cadaver option in this regard.

Thanks for your concern. As far as I know our son is doing well. Let us know what you decide and keep us posted. Your son will be back at it soon.




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There are obviously pros and cons of all three types of ACL grafts. First, though, I'll mention the hamstrings muscle group consists of three muscles as gotwood noted. The Biceps Femoris, the Semitendinosus, and the Semimembranosus. Oftentimes, they harvest a slice of the Semitendinosus. This is okay because it will regenerate to some extent. Also, this muscle's actions are shared with all three hamstring muscle as well as the Sartorius and the Gracilis muscles to a degree. The Sartorius, Gracilis, and Semitendinosus share a common tendon and insert on what's called the pes anserine which is found on the medial side of the proximal tibia.

Patellar Tendon
Pro
-Bone-tendon-bone graft often "takes" better due to the bone that is inserted into a hole essentially.

Cons
-Pre-patellar pain that normally lasts for a LONG time. Often something that will be nagging for the rest of your life.
-Patellar tendon weakness
-Scar
-Single strand
-Additional "injury"

Semitendinosus Tendon
Pro
-Double strand
-Less pain
Cons
-Potential semitendinosus weakness
-Additional "injury"

Cadaver graft
Pros
-Normally an actual ACL
-No additional "injury"

Cons
-Risk of rejection
-Risk of infection
-Seems to be higher risk of re-rupture
-Some people think it's gross

This is just a brief outline of the different types of grafts.

John, keep us updated. Hopefully surgery goes well in the morning and he can get back on track to recovery ASAP! Ask away if you've got questions...

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Wow Bulldog! That truly was an excellent response.

I'm glad I knew just a bit of what you were stating, otherwise I would have thought I was reading the screenplay for...




Thanks again for the concise explanation. It is appreciated.




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I second that WOW Bulldog!!! After reading through that I am somewhat leaning to the cadevar option (?). We're leaving to go the hospital in about a half hour so we'll see what happens...

I did not know Bulldog was a doctor

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There's a lot you don't know about Bulldog !




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I did not know Bulldog was a doctor

I did not know anybody had said I was.

Bulldog has done a nice job of summarizing above - the one thing I would add is that the Doctor performing the surgery is almost always most comfortable with one approach or another and thus will prefer that option.

My son's doctor, said that, in his experience, he preferred the cadaver over the other two options because:

1) the hamstring option resulted in a weaker hamstring and a higher probability of loss of explosiveness and tendency towards pulling hammys in the future. He did like the hamstring option for people who played either non explosive sports (e.g. golf) or played at a recreational level.

2) The Patella tendon he found lead to a longer healing time due to the additional injury in harvesting the patella tendon as well as to a weakening of the kneecap.

So 08Son had the cadaver option.

For what it is worth, Tiger had the hamstring option shortly after my son had his surgery done. I thought it was interesting that the Dr. had used golf as his example of a sport where the hamstring option was best.

Jerry Rice had the patella tendon option back in the day - and fractured his knee cap in his first game back. On the other hand, millions of people have had this version without that problem so it may have been a freak accident.

Hope this helps,

08

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the one thing I would add is that the Doctor performing the surgery is almost always most comfortable with one approach or another and thus will prefer that option.

Good point. I know many physicians prefer the patellar tendon graft... or so it seems.

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Jerry Rice had the patella tendon option back in the day - and fractured his knee cap in his first game back. On the other hand, millions of people have had this version without that problem so it may have been a freak accident.

He also returned in something like 2 months?

Son had the patella graft and everything went as expected. Also had a meniscus tear that had was reason for not being able to straighten the knee. Torn meniscus particles got under the capsule...Dr. used an epidural like nerve block and helped block pain but it supposedly will wear off in 12-20 hours and he needs to start on percocet and valium before it wears off. Also has a brace on that has some sort of ice machine contraption that automatically ices area...Poor kid is really wiped out from the anesthesia and a little overwhelmed by all of it...BTW- Bulldog was spot on on all of his information he provided- Thanks everyone! John

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Also had a meniscus tear that had was reason for not being able to straighten the knee. Torn meniscus particles got under the capsule

Did they fix the meniscus or just trim it? What is the name of the machine? Is it a CryoCuff system or a Game Ready? I've heard of a lot of people having a CryoCuff after ACL surgery, but we've got an athlete right now who was given a Game Ready unit recently after surgery...

Meniscus was just cleaned up and the damage was limited to the outside part of the knee. The ice machine he's got is called an Polar Care 300 and it is made by Breg. He's doing much better today than right after surgery...

Glad to hear that the surgery went well - best wishes for a speedy and 100% recovery. Please feel free to PM me with any questions you might have.

Bulldog- I sent you a PM regarding Adam's knee...

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Bulldog- I sent you a PM regarding Adam's knee...

I haven't gotten it yet, but I'll keep looking for it...

Here's an update regarding the ACL/meniscus surgery and rehab for those that have posted:

July 9th was three months post-op. Son doing reasonably well and his range of motion, which initially was a major problem, is pretty good and on back track. Presently the PT is working on strengthing the leg muscles back. The muscle atrophy was significant- the two legs looked like they belonged to two different people- one (his non surgical leg) looked like a normal, 6'3", 220 lbr and the other like a 6'3" 140 lbr. Also doing light squats, leg presses, calf raises, water work...he has been throwing for a month, mainly playing catch and long tossing and some 50-75% BP off of a mound (although PT doesn't want him off a mound yet). Hopefully he'll be on track to pitch at 100% this fall. Not going to play a position or bat, run, etc...no football either...big problem now is his elbow tendinitis when throwing. Back part of elbow 3-4" up towards tricep...only hurts when he throws, is able to do his upper body weight lifting with no issues and is manageable but nevertheless concerning. The PT guy says it is normal after resuming a throwing program after not doing any throwing for 90 days...he needs to do his band work and stretching but it's hard to get him to do it...

Glad to hear that Adam is doing well. ACLs are so difficult to rehab from because of the lengthy time involved and the slow process of regaining strength in the leg.

The arm tenderness sounds normal - glad that the PT is watching it. Probably need to back off a little bit - also do the Jobe exercises with little dumbbells.

John,
Last week our son tore his MCL/ACL and hopefully just minor meniscus on the edge/top/corner... We are now doing pre-op rehab on the knee with very high hopes of a full recovery. His range of motion is very good and unbelieveably there was almost zero swelling. After getting a couple of opinions we are satisfied that we have a very competent Doctor. He is scheduled for surgery next Friday, the 4th. I appreciate you sharing your story as it has already peaked my interest in your son's recovery. I would love to hear his experience through the entire and baseball return ? Our son is a Sophmore with a very bright future and advice or comments concerning this whole knee injury ordeal is greatly accepted !! I am thanking you in advance in VB.

driller, let me know if you have questions along the way. I've worked with a few athletes over the last couple of years with ACL injuries.

Make sure you have a surgeon you are comfortable with and a PT or athletic trainer you're comfortable with. Recognize that while most any PT will be able to rehab this injury according to insurance standards, not every PT has the background to rehab an athleitc injury..

Driller, I am so sorry for your son (and you and his mother). At this moment you're probably pretty depressed and understandably so. Adam is now 9 1/2 months post op and is probably 90% recovered. He got a complete release for all activites at the end of September. I see where my last post was July 18th. At that point he was still going to rehab and just palying catch/long toss and 1/2-3/4 effort bullpens. He progressed to taking batting practice by August and pitching competitively at full effort by mid August. He'd get on base and we'd pinch run for him. He tweaked the knee a time or two planting the leg while fielding bunts/weak grounders but nothing serious. After the insurance ran out for the PT he kept up the leg work at 24 hour fitness and is now back to squatting 315 lbs six times, doing leg sleds, plyometrics and the quads are about equal.

As far as what I can tell you to expect is, first and foremost, everyone is different and recovers differently. There is no one "fits all" protocal or schedule for recovery. Just take it slow and steady and stay with the PT. Adam took almost a month before he was not using at least one crutch to walk. I think he was really scared, particularly after the surgery, at the amount of pain he had and was scared about reinjuring it. So he was very tentative of pushing the envelope...I wish he would remember that now as I catch him horseplaying around trying to dunk basketballs, and doing what normal 16 year olds do. Worries me to death... Also, try to enjoy not having to play baseball and take a summer vacation or two and do things that "normal" kids and families do. You'll have the fall and two more high school and summer seasons to get back to playing the crazy baseball schedules that we lead.

You don't say what type of ACL reconstruction he is going to have. The patella is what Adam had. Where they harvested the patella is where he gets the most pain and discomfort. It is supposed to subside over time. We chose that route as the best long range option as the patella will regenerate where the hamstring is lost forever. Thh allograft (cadaver) option is too risky to infection, rejection and future rupture. The Mizzou surgeon does them and has had a couple not go so good (Google Danario Alexander knne surgeries)

Best of luck to you and your son and please let me know if there is anything else that I can provide. Bulldog is knowledgeable and gives good advice too...

John & Dog,
First of all THANK YOU both for responding so quickly ! As you both know this is a very trying time for all. My head feels like I'm in my first day of Calculus class Freshman year, overloaded, but learning a ton in a short time. John, I'm really happy your son is back to "dunking" basketballs again ! That is very encouraging. Bulldog, we are at peace with our Surgeon and PT guys as they both deal with college and professional athletes from our area all the time. Today (this morning 6:00 am) was his second pre-op PT. PT appts. are scheduled for every other day. Is this enough ? Is there anything you guys would suggest in between or does the knee need recovery time between PT visits ? He will be operated on next Friday so I don't want to waste any days that he could be strengthening before then ? I sincerely appreciate your words of experience.

If he was given a home exercise program, he should be doing that. Otherwise, I would not do more than the PT tells him at this point.

Three goals going into surgery: 1) Eliminate/reduce swelling. You said there really wasn't much to begin with and you don't want to develop any. If you try to do too much you could cause inflammation and swelling to take place. 2) Increase range of motion as much as possible. With a meniscus tear, this goal may be modified to some degree. 3) Go into surgery with as much strength as possible. He needs to have that neuromuscular activity ready to go. Once he goes into surgery, you'd be amazed at how fast that muscle strength is just gone. The more he goes in with, the quicker it comes back afterwards.

And really these three goals are the same three goals he'll have coming out of surgery. Rehab has already begun, brief interruption for surgery, and then rehab gets started the same day. It's a long process that you just have to take one day at a time.

Lots of small goals with one ultimate goal at the end.

Big thing with Adam's "prehab" before surgery and also the "rehab" after it, was getting the knee and leg completely straight. Apparently some of the torn meniscus was under the knee capsule precluding the range of motion. Also, he didn't have much pre surgery swelling either and we almost were going to not get it checked out and just brace it and play...BTW he's not dunking yet, just trying.

Hey Bulldog- How's it going down there? I think that you guys missed the bulk of this weeks big winter storm? Question for you regarding Adam's knee. He still experiences quite a bit of pain on in the knee, particularly after a strenuous "indoor" workout on the old astroturf (at Velocity) and less so, but still pain, on the field turf at the the Pirates Sandlot facility. He also will feel pain while doing his squats/leg sled strength training. Is this common with the patella graft? Seems that after ten months it shouldn't give him the pain that he's experiencing...

Hey Driller- please let us know how your son is making out...hope all went well!

john, where's the pain located at? Front of the knee? Feel like it's on the patella or inside of the patella?

Actually, I've moved home and am back in the St. Louis area now. All my SEMO friends are upset they didn't get this weather, but as far as I'm concerned, they could have had it!

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Originally posted by johnj314:
Question for you regarding Adam's knee. He still experiences quite a bit of pain on in the knee, particularly after a strenuous "indoor" workout on the old astroturf ... Is this common with the patella graft? Seems that after ten months it shouldn't give him the pain that he's experiencing...

john, you mentioned that your son had some meniscus fragments removed. My guess is the pain is coming from the point of where those fragments were, rather than from the graft. There could be some bone-on-bone contact, now. It may have even torn more. He should get it looked at.

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Bulldog, the pain/soreness is on the front of the knee, on both sides, from about the kneecap down...

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He still experiences quite a bit of pain on in the knee, particularly after a strenuous "indoor" workout on the old astroturf (at Velocity) and less so, but still pain, on the field turf at the the Pirates Sandlot facility. He also will feel pain while doing his squats/leg sled strength training. Is this common with the patella graft? Seems that after ten months it shouldn't give him the pain that he's experiencing...

Sounds to me like it would likely be due to the patellar tendon graft. The pain sounds like it's right there in the patellar tendon where the graft was taken from. I don't know how long that pain tends to last, but it is something that I have learned is "normal" for those with a patellar graft. They often have pain on the anterior aspect of the knee from the graft.

It's why I have reservations against the patellar tendon graft for many athletes.

John/Bulldog,
Son's surgery was 17 days ago (feels like 3 months ago...) He had the Patellar graft performed on the ACL. Surgery was very successful; however, MCL was stretched a little more than originally thought and had to have that tightened up and stitched. The first post-op meeting with the surgeon was 11 days after surgery. At that appt. surgeon trained approx. 60 cc's of crude/blood from the knee. Is that tyipcal/normal ? Swelling went down immediately and the knee is almost the size of the other one already. PT is going good so far and making strides each visit. Son is lifting very light weights and mostly doing lotsa range of motion exercises. His range is was measured yesterday @ 110 degrees ? What is the optimum range we should be looking for ? Only real problem has been keeping him from hobblin' around without his crutches ! Due to the MCL stitches he was ordered to have no weight barring on the repaired leg, only toe weight... Physical Therapist has given him a goal of 5+- months to return (with brace) to the field ? I'm sorry it took this long to get back to ya, but I wanted to have more info from which to ask my questions. Last question ... Does it get any easier on the parents ? I swear it feels like I picked up a part-time job !!

driller, I wouldn't be worried about having drained blood and such. I'm actually a little surprised that he is doing much flexion at this point if there was significant damage to the MCL, but that can sometimes be a situation-specific call. Range of motion in flexion (knee bending) sounds pretty good at this point. ROM is going to depend on what is "normal" for the other leg. Ideally we'd like to get back to 135-145 degrees. I've been told you'll never get past 140 in a PT clinic-- insurance would cut you off at that point.

What's the timeline to begin weight-bearing that they've given you?