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,

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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