The ACL Surgery Decision

Whether it was the effect of intensive exercise or wear, I started feeling recurring pain and went to Doctor again to have the knee checked. Finally, my PCP referred me to Dr Bach. I went to DR Bach on 14th March. When I told him that I have been very active in the last 4-6 months, he again suggested that if I wanted active lifestyle, I should go in for surgery. So, I took the plunge and booked the first available date of Mar 20th. I knew that if I delayed again, I would be in teh same situation 12 months from now.

The only main decision was, what I wanted to use as a graft. There are a lot of websites that will help you make a decision. Here is one that is one of the most comprehensive

In short with out the medical jargons, there are three ways (Disclaimer: do your own research and don;t use this as the sole basis and come after me)

1> Tendon from knee cap: They take one middle one-third of the ligament along with small bone fragment from each end from your the knee cap. They have to make additional 3 inch incision on your knee to get the ligament. As there is bone on both the ends, it has strong bone to bone fix.

Issues to consider:
a>The main disadvantage is the it will weaken your knee cap and you have to take care of it as it can break if you have a fall after the injury. Some views mentioned that the knee cap ligament strengthens with time.
b>Another disadvantage is more pain (especially while kneeling) and longest recovery time.
c> Longer surgery time as they have to get the tendon from your body

2> Hamstring/Quad tendon: Instead of kneecap, they get a tendon from hamstring/quad. As there is bone on just one end, the fix is not as strong as other two options.

Issues to consider:
a> No additional risk of knee-cap fracture during or after the surgery.
b>Less pain than knee tendon and medium recovery time.
c> Longer surgery time as they have to get the tendon from your body

3> Tendon from another body: Here they take tendon from another donor's dead body. This procedure is shortest and has the least amount of pain. There is no incision to get the tendon from your body. Also as most probably the tendon has bones on both ends, it gives similar strong fix at both ends as in knee cap tendon.

Issues to consider: Though this is the least painful and shortest recovery options, one has to consider the following issue.

a> risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing. The risk is less than one in million and as per Dr Bach, last known case was in 90's.

b>Bacterial infection due to incorrect sterilization. According to Dr Bach the probability of this is 1 in 200 to 1 in 300. He has seen 6 cases in his life. Using a well known hospital will help here too as, he mentioned that if caught early they can open the knee and flush the tendon. Some articles have mentioned that this has led to deaths too in extreme cases.

Finally, here are some facts to consider:
1> There were about 42,636 car accident deaths in 2005. An average of 115 persons die each day in motor vehicle crashes in the United States -- one every 13 minutes. According to the World Health Organization about 3000 people die in crashes each day worldwide.

2> There are 6 billion people in this world and 300 million in USA.

You are almost as likely to die in a car accident in US or World than get an HIV virus through donor's tendon.

Overall, which ever method that you feel comfortable with is fine as long as you use an experienced doctor and well known group. Success of surgery has high correlation with the skill of the doctor and post surgery physiotherapy discipline. If you are in Chicago, I would recommend Dr Bernard Bach, based on my experience with him so far.

Another decision variable is when to go in for surgery, I would suggest give it at least 2-6 weeks, but don't wait years like me. You will wear your joint unnecessarily.