Thursday, March 22, 2018

ACL Reconstruction: Allograft vs Autograft?

I saw the surgeon yesterday.

Surgery is the path forward, especially given my goals of staying active and continuing to compete at a high level in cyclocross. My unique goals and age put me in a unique box that, frankly, my surgeon has not seen before in terms of deciding between autograft or allograft. If I were a 25 year old national level soccer player, there'd be no question about it, and we'd choose the Gold Standard; patellar autograft, a procedure in which a segment of my own patellar tendon is harvested for the reconstruction.

 However, given my love of cycling and goal to one day win a national title, he is hesitant to do anything to upset the knee any more than necessary. In particular, he feels the repetitive motion of pedaling could irritate the resultant scar tissue of the patellar tendon, if we were to take that route. The hamstring tendon is another option, but given its involvement in knee flexion, the surgeon feels it carries the same issues relative to irritation over the millions of cycles (pun not intended) in pedaling.

The allograft, or utilisation of cadaver tissue for the reconstruction, apparently fares about the same statistically as the autograft in older patients. While I agree with the surgeon on not wanting to cause insult to any more of the knee that has already been done, I wonder how much of the data for older patients is skewed by the fact that most patients over 40 suffer this kind of injury and then naturally slow down and/or cease to participate in physical activity. If this is true for a majority of those undergoing ACL reconstruction, then the material used really doesn't matter since it's not really being stressed. I know one such patient who, while never as avid a skier as I, has sworn off skiing in the wake of her surgery. I wonder for how many in the data set used to tout the efficacy of using cadaver tissue this is true. Even without my lofty cycling goals, I hope to remain active in many sports, such as skiing and kiteboarding, that while not necessarily heavy on the cutting and pivoting, remain very high energy.

On the other hand, cycling is a relatively straightforward pursuit as far as the knee is concerned. There is not a lot of cutting, pivoting and sudden change of direction. These are the things that really beg for -- and tend to stress -- a functioning ACL. That said, cyclocross is a unique beast, with frequent dismounts from and remounts on the bike, jumping over barriers, running through sand and/or muddy, slippery terrain. Changes in direction may be small and infrequent, but when they occur they can be sudden, unexpected and forceful. I'd meant for this to be an unbiased, un-opinionated explanation of how my surgeon and I saw the various options, but I may have just made my decision.

What are your thoughts?
What was your experience when having ACL reconstruction?
Would love to hear from everyone, but especially from cyclists.

No comments:

Post a Comment