Well, I did it again. In December of 2006, I was "just skiing along" when I caught a rock at just the wrong time. Pop!
I did the left knee this time, my 'good leg'. Thanks to my buddies for helping me get off the mountain without a helicopter.
This one was a full tear from the get-go. I am living in Montana now, so I would be seeing a new doctor.
As it turns out, I had significant tendonitis problems as a result of my BPTB graft the first time, so I did not consider the patellar tendon graft again. Fortunately, Bozeman has some great knee doctors, most of whom are capable with all graft choices. One of them mentioned the quad tendon graft, which I had never heard of.
I did some homework on this graft and decided it was the best choice. In fact, it seemed like a no-brainer to me. Here's a few reasons why:
-The graft represents 1/5 of the quad tendon as opposed to 1/3 of the patellar tendon for the BPTB graft. So you are leaving more of the original equipment intact.
-You do not kneel on your quad tendon, so you do not kneel on your harvest site. This was a huge pain for me the first time, and four years later kneeling still feels wierd.
-No nerves are severed during harvest like with the BPTB. No numb spots.
-The risk of patellar tendonitis is greatly reduced. I have read that it is about 25% likely with the BPTB.
-The hamstring graft has its issues - possible laxity and the fact that the harvest areas don't fully regenerate.
-The allograft is known to be the weakest and my insurance doesn't cover it anyway.
Surgery was 2/20/07. I highly reccommend a femoral nerve block - you won't feel a thing for 24 hours after surgery. You can save your first day's pain meds for a rainy day.
Post op was pretty much the same as for the BPTB: #####ty.
I am at ten weeks now and would say I'm doing very well. I'm in no big hurry - my focus is on long term success - but I am biking a lot and swimming. Weights too. The only problem so far has been with the washer-loc screw in my tibia. It is used to fix the soft tissue end of the graft (the other end is bone). It is the size of a drywall anchor. It protrudes a little - I'm guessing more than the doctor intended. So it rubs and was very painful for weeks 6-8. It has gotten a lot better and I have a nice lump on my shin where the screw is.
I suspect that my quad will take a long time to recover, maybe more than with the BPTB. However, I'm sure it will be fine in the long run and I will have no patellar tendonitis. I was able to kneel at about 4 weeks. I couldn't do this for nearly two years with the BPTB.
Proprioception feels much better than it did at this point last time, but I do think the swelling pattern with the quad graft makes walking more awkward at first. Wall sits and step downs were also very painful in the early going as they directly work the wound site. I am trying to go easy on this type of stuff to avoid tendon problems. I assume there is a risk of that with this proceure, too.
I will update this when I'm fully recovered.
UPDATE 10/8/2008
It's been about 20 months now. I skied about 30 days last winter and experienced a fair amount of pain in the graft harvest area. I definitely had diminshed power from the affected leg. The good news is that the patellar tendonitis from my first surgery is all but gone.
Over the past several months, I have been bicycling a lot. This doesn't bother the leg much. However, hiking downhill, especially with a heavy pack on, brings on a 'charley horse' kind of pain in my lower quad. In fact, this pain is virtually always present whenever I flex that quad. That being said, the leg is strong and stable. I figure that it will take another year before it feels normal again. The first one took almost three years! I guess I'm just a slow healer.
I also have a 'hitch' in the quad tendon graft knee. If I hold my leg fully extended for a few seconds, it tends to lock in place. This has not lessened at all. I am going to have it checked out because I'm worried that I might be doing damage to my cartilage.
Overall, I would say the jury is still out on the quad tendon graft. My biggest fear is that it has compromised my quad in such a way as to rob me of the explosive power needed for technical skiing. Again, I have a record of healing slowly so I don't feel I can make a definitive statement until a good three years goes by. I will say that I have been pleasantly surprised with how my right leg (BPTB in '03) has responded to the left being injured. The tendonitis that was such a pain the previous 2 1/2 years went away and I have a lot more confidence in that leg now. I an only hope that time will produce similar results for the left leg. In any case, I think that doctors' claims that your leg will return to 100% after an autograft are B.S. I'm quite sure niether of my legs will ever be as good as they were in their original form.
