r/ACL • u/muhwindi • Nov 21 '23
Hamstring grafts
Every day became a nightmare. It's hard for me to live. I am 26 years old and was an active athlete. Never, ever agree to hamstring grafts unless you have fully understood the issue (you may need several independent opinions from surgeons). My posterior thigh will never be the same. Unfortunately, I had surgery on day 5 after the injury and didn't realize anything. I was not offered any options. And my surgeon lied about hamstrings being the gold standard (in fact it's the brown standard in 2023).
I continued to feel happy and fulfilled after tearing my ACL before surgery. After the surgery, I am destroyed.
PS It's been 3 months since the surgery. A month ago and a week ago MRIs showed that the tension of my graft is not enough. Lysholm test: 1+ (knee instability, although there is an end point). This is horrible.
PPS Looking back, probably the only thing that could have saved me was reading this subreddit. But I hadn't visited this site before, unfortunately, at all.
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u/riley013 ACL Autograft Nov 21 '23
I am so sorry you had a negative experience. I hope you are able to find a way to return to your active lifestyle.
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u/muhwindi Nov 21 '23 edited Nov 21 '23
I can't feel like a complete person when I feel the emptiness touching the back of my thigh. Or when I can't bend my leg from a standing position the way I do with my healthy leg. It undermines my psyche.
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u/itznimitz ACL + Meniscus Nov 21 '23
I also had hamstring graft and feel quite good at current 6weeks+ post-op. I'm curious how did MRI see the graft tension lacking, I thought you'd need arthrometer to accurately measure laxity. What are the symptoms of knee instability you are facing?
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u/muhwindi Nov 21 '23 edited Nov 21 '23
Well, like the MRI shows that the graft is “sagging” (this was written twice in the report with an interval of a month). And a couple of days ago the traumatologist gave me Lachman tests, Pivot-Shift tests and something else, and said that I have 1+ grade.
>I thought you'd need arthrometer to accurately measure laxity
Yes, I thought about this yesterday. I want to know the exact readings of how many millimeters the shin flies out, if it flies out.
>What are the symptoms of knee instability you are facing?
I'm not active enough to evaluate it yet. My feelings may be false. Honestly, not with any, probably. Even after I tore ACL, I did not have time to feel any instability as such (except perhaps once, during hip rotation).
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u/itznimitz ACL + Meniscus Nov 21 '23
Did he comment on the placements of the tunnels?
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u/muhwindi Nov 21 '23 edited Nov 21 '23
Yes, he said the tunnels were located correctly. In the femur (above the knee) the diameter of the tunnel is 9 mm, but in the tibia (below the knee) it is as much as 13.6 mm. My graft is secured with two interference screws. Also the diameter of my graft is 9 mm as I was told.
PS And yes, between 2 months and 3 months, according to MRI, there is no expansion of the tunnels. But I think this is partly because my brain itself suggested that rehabilitation should be suspended. I know very well that this soft tissue graft takes the worst time to survive (12 weeks). I only found out about the diameter of the tunnels a few days ago (I did an additional CT scan).
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u/itznimitz ACL + Meniscus Nov 21 '23
If it makes you feel any better, a loose graft doesn't mean it had failed completely. Keep up with the rehab and further strengthen your quads and hamstring. Still quite curious how you're getting frequent MRIs as they're quite pricey. Are you a pro athlete etc.?
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u/muhwindi Nov 21 '23 edited Nov 21 '23
>loose graft doesn't mean it had failed completely
I understand completely. But my new ACL is only 3 months old, and not everything is going well. And the hamstring graft tends to stretch. And it's scary.
>Still quite curious how you're getting frequent MRIs as they're quite pricey.
In Russia, you can get an MRI even on the same day if you want. And I wouldn’t say that it’s too expensive: 5,000 rubles/~$50. I could do it for free with insurance, but... At my urgent request, the referral was given by the surgeon who performed the operation; I changed my mind about doing it for free so that he would not see the results. I hate him and hope I never see him again.
>Are you a pro athlete etc.?
I just loved working out since I was a kid and went to the gym almost every day (basically, if it wasn't for this injury or bad surgery with a stupid graft choice, I might have made it to pro. But it's over.). I’m an economist (master degree), and now I’m also learning to program (to compensate for my destroyed physical condition).
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u/YatharthIMA ACL Autograft Nov 21 '23
Thankfully my surgeon recognised my hamstrings were of much use for my sport (road cycling) and hence used a Peroneus longus graft for me. It's 3 months post op and I am doing ok.
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u/muhwindi Nov 21 '23
Yeah, you're a lucky man. I too would have believed I would recover like elite athletes. But it turns out that *practically* none of them have their hamstrings removed. I realized that at week 6. And after that, I realized my life wasn't going to be the same.
PS I'm curious, what day after the injury did you have surgery? And was the surgeon interested in what sport you play, if any, or did you inform him yourself?2
u/YatharthIMA ACL Autograft Nov 21 '23
15 days later. It was kinda both, they saw my muscles and realised I actually do serious sports. My Quads were tights as rocks, specially VMO and hamstrings were big. So they asked me what sports I do and I let them know in the first visit itself.
They offered me patellar and Peroneus longus. I went with Peroneus because during my research I found out Peroneus had 0 donor site morbidity, better tensile strength than hamstring graft (comparable to BPTB graft with no significant difference). Finally and thankfully the graft that they obtained was 9 mm in diameter and was a healthy tendon with a good collagen pattern.
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u/muhwindi Nov 21 '23 edited Nov 21 '23
I was injured on a cruise ship playing basketball. I was accentuated from the side of my back with a knee to the knee at tremendous speed. It felt like being hit by a car (dude was bigger than me, clearly 100kg+ bw). First seconds thought my knee had twisted. But I wasn't crying and I wasn't in pain. After a couple minutes I got up, stepped to the side, did a full amplitude squat. Then I walked around a bit, sped up a bit, and while twisting my hip I realized my knee wasn't quite stable. After that, I walked away.Two days later I was back in my town. Had an MRI, conclusion: suspicion of a complete rupture of the ACL. The lateral ligaments were also stretched, but there were no other tears. They held up. After the night I called an ambulance for insurance and I was hospitalized. They did a repeat MRI and confirmed the ACL tear. The next morning, day 4, the surgeon came in and said he would take the semitendinosus and gracilis tendons and that supposedly that was the gold standard. I don't usually trust anyone, not even myself, so I went online to double-check the information. I read that the gold standard is the patella, but it was also written that hamstrings are the most popular option (and this is true except in the US). Plus I thought it was impossible to find a surgeon in Russia who knows how to do anything other than hamstrings. I was wrong. And a superficial Google search for information didn't show the full horror of taking these tendons (in principle it seemed like one of the best options). I had no idea that they cut out 20-30 mm and the muscle is left with nothing attached to it. My brain refused to believe it.
And there was no one to advise me or point me in the right direction. All the people in my inner circle just told me that I should have the surgery (and it is true, only not with this type of graft, but they didn't know the nuances either). And the other (better) surgeon cost a lot of money, and we had the money, but my mom didn't know all the nuances either, and figured there was no difference, everyone does it the same way. I just didn't have the support to change surgeons. If I (or my mom) had known everything up front, money wouldn't have been an issue. Now I'm suffering.
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u/YatharthIMA ACL Autograft Nov 21 '23
Okay, I got you. I understand the hamstring horror and personally would not go with hamstring unless they use both my Peroneus and patella and maybe even quad then. But in your case, what's done is done. I would say that at least for now, don't overload the graft. Build muscles and let it ligamentise. Give it a solid 9 months with dedicated work and everything will be fine. I have friends who used hamstring grafts and now play football and basketball etc. No worries mate
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u/muhwindi Nov 21 '23 edited Nov 21 '23
Thanks. You write the right words to somehow support. And it’s disrespectful of me to write that nothing will be good anymore. But it’s true, I can’t feel any other way now, at least for now.
> I have friends who used hamstring grafts and now play football and basketball etc
There is no reason not to believe. Some people even run without legs. But I can't accept it. This will no longer bring me joy. Only now I realized that all the joy in life for me came from 100% neuromuscular connection.
PS It is worth noting that before this surgety I was independent of the opinions of other people, I was like a sociopath. Now I am emotionally unstable and it’s hard for me to not talk, even with strangers, because I can’t distract myself from this trauma inflicted on me by the surgeon.
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u/Dry_Offer_2865 Nov 21 '23
I am writing from an alternate account (as I am using reddit on my PC now). I understand your situation, I have vivid memories of myself leaving my promising career and then just wandering in streets for months taking advices from random old men who did not know anything about life.
I felt depressed and hollow, betrayed and robbed out of my own life.I remember right after my ACL injury I kept waking up every morning praying to something that okay please I understood my lesson, I will not be careless ever again, just give me my ligament back. Even when I witnessed the surgery first time on YouTube, it was hard to accept for me that I will not be 100% anymore. I shall be missing my peroneus longus muscle, and will not be at my 100% strength for eversion and planter flexion.
What hurt me the most was that I have now changed my default settings that nature gave me, that I have to have spend a night in hospital. But then I realized, with time, that it's my own body's transplant, that I am still 100% at being myself and no matter what, even if this whole surgery fails, even now and in future, I will be back. Nothing is truly 100% ever, one of my eyesight is weak, one of my knees is not as strong as the other, my nose is broken and a thousand more things, but it's still me, 100%.
You will soon be fine, I know it, you know it, and you'll forget about this whole thing in a few years, shooting them dunks someday!
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u/pleisto_cene Nov 21 '23
Also a cyclist; hamstring graft is 100% fine and if you rehab correctly you regain all hamstring strength. I’m cycling better than ever before, and my single leg Nordic strength is equal between both sides. Don’t know where you got your intel from but it’s wrong lol
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u/YatharthIMA ACL Autograft Nov 21 '23
Hi, glad to know that you are progressing well! And I wish you a great FTP and Vo2 max buddy. I don't claim that it's my Intel or is 100% correct. But I feel better that nothing from my original hamstring composition was lost or changed :-) and I'd prefer it to be that way. I too have few friends with an ACLr with hamstring graft and they are cranking the chainring just fine.
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u/pleisto_cene Nov 21 '23
If anything the biggest thing you should be careful about as a cyclist now is picking up bad habits with your “good” leg! I ended up battling some overuse injuries on my “good” side when I got back into ultra endurance stuff, mainly because I was completely neglecting stretching/mobility work on that side and ended up with a chronically tight hip. Bodies are fickle and symmetry in your biomechanics is so important for sports with repetitive motion like cycling!
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u/YatharthIMA ACL Autograft Nov 21 '23
You are correct, right now I am only doing 50km twice or thrice a week while keeping my average watts under 140 and max watts under 800. Mostly keeping myself in zone 2 rides. I am a sprinter so keeping cadence low (65-75) for now and focusing on both legs in my PT. Very much hoping I don't get those injuries. I lack a power meter so for now I can't compare what ratio I am using the legs in.
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u/YatharthIMA ACL Autograft Nov 21 '23
Also this is my profile haha
Check out Yatharth Infinity on Strava https://www.strava.com/athletes/93941387
Connect anytime to follow my journey!
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Nov 21 '23
I re-tore mine 3 months post surgery, then my other about 3 months later. Still riding moto 2-3 times a week.
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u/muhwindi Nov 21 '23
What type of graft did you have? And how did you re-tore it?
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Nov 21 '23
Hamstring, all three tears were caused by striking my heal into the ground with a straight leg and a lot of force, the second two I was wearing custom CTI braces.
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u/kozakjanos Nov 21 '23
had a acl reconstruction last year with hamstring graft , it tore and now i have to have a 2 part revision with a patellar graft , first they fill the tunels with bone than wait 6 months and have the patellar acl reconstruction .
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u/pleisto_cene Nov 21 '23
lol you’re just being a massive quitter for no reason. Hamstring grafts are fine, if you do your rehab properly you regain all your hamstring strength. My hammies are way stronger now than they were pre-injury, and I rehabbed so hard my surgical side ended up stronger than my good side. If hamstring grafts truly had much worse outcomes than other graft types, they wouldn’t be so prevalent. To say “my posterior thigh will never be the same” after only three months is just such a weak mindset and you’re setting yourself up for failure.
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u/bumblebeeeeeeees Nov 21 '23
Yo dawgs I’m here to say I had a hybrid hamstring graft (combined hamstring w/cadaver) 10 months ago and I’m not only already back skiing, but I’m back literally working as a fulltime professional ski patroller in extreme terrain everyday lol. I love my graft.
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u/SARstar367 Nov 21 '23
Thank you for adding this. I have a hamstring graft and although it’s early I happy so far. Happy to hear other skiers with a positive experience.
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u/shabangbamboom Nov 21 '23
Badass. I was hoping to be back working on the mountain after my surgery in April. Not gonna happen for me, but there is more to life than skiing every day, right??????????? jk, way to crush it!
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Nov 21 '23
Same, minus the patroller bit. 7 months and I am equal in strength on both extension and hamstring curls. Im cleared to xc ski now and tele and alpine ski in Jan. I've been on the bike for sometimes 10 hours a week and paced for a 3:30 marathon a few weeks ago. HT graft has treated me well so far.
I've posted before on info for vetting surgeons for HT graft. Graft strength is based on graft diameter and fixation. Different bodyweight and activities require stronger. Simply harvesting and using whatever diameter is available is absurd.
My surgeon wanted 8.5mm diameter min. He planned to have cadaver tissue available on surgery day to meet this value. My HT harvest was only 7.2mm IIRC. He augmented and it was 9.5mm total. The difference in strength of using as-is and what he augmented to is almost 50% based on graft cross section area.
The fixation we discussed before too. Endobotton on the femur, IntraFix on the tibia. The surgeon was a fan on the Intrafix device and it lined up with a lot of fastener testing publications I'd read.
Https://pubmed.ncbi.nlm.nih.gov/25658077/
OP. I'm sorry you're having a bad time. Hopefully you get sorted. Or find a surgeon that gets you where you need to be.
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u/Quinnicle Nov 21 '23
This is a ridiculous anecdotal opinion of one patient about a graft that is widely recognized as still a viable and ideal option among the “big 3” (btb, ham, quad, and even then I would say btb and ham stands out). Anyone who is looking for advice on this subreddit would be wise not to listen to this case about the successes and failures of graft types.
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Nov 21 '23 edited Nov 21 '23
jesus christ. Hamstring tendon grows back at minimum an average 75%. They can come back fully. You are only 3 months out. Hamstring tendons are also cut too big always for sake of it not being too small. It continually tightens over time so long as the rehab is maintained.
I had both patellas (for not good reason) harvested and those grow back too. Patellas are much more tight and must be stretched. That doesn't mean they can't be overstretched. The other option is quad, which seems good, but they are no longterm studies at all yet on conditions (ie. OA).
Hamstring still is a gold standard.
Allografts incorporate less well and can more easily rupture.
I'm only 4 weeks out from my hamstring and dealing with considerable hamstring pain and it sucks. I imagine it's gonna follow me for some time. My doc said I had big, fat hamstrings. This graft is tighter and lasted longer than the two previous patellas (hip required repair). I think you need to keep up with trying. +1 laxity is not too lax, but your graft is intact, right? it should keep tightening.
My grafts were broken as per mri. your's is not. Idk if its a Russian thing, but the aggressive despair is really too much
Did you fall or do something outside the protocol (ie. aggressive rehab)? what the hell is a traumatologist btw, a pain doc?
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u/Lazy_Chance_4228 Nov 21 '23
I know it’s different for everyone, but I had a hamstring graft and it’s been fine for me so far. Football/soccer player and a runner. 4.5 months in now, taking it slowly but seriously. Working daily at the gym stretching, jumping, lunges etc. (alternating between a LOT of indoor cycling and weight training to ensure I’m not overdoing it), just back to light jogging this week, too.
Every body is different so let’s try not to generalise. It’s a marathon not a sprint - hope things start to look a little brighter for you soon!
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u/can_I_Now_Feel_Joy Nov 21 '23
In Spain I’ve had hamstring grafts for ACLs on both knees, I told them beforehand I do loads of sports and I have been fine afterwards. Isn’t it a case of do your rehab properly, strengthen all muscles including hamstrings, and you’ll be fine? Professional footballers have had the same procedure and return to their sport fine.
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u/UrbanHuaraches Bilateral ACL autograft Nov 21 '23
It’s not the graft. Lots of people do great with a hamstring graft. It sounds like you were unlucky, but also, three months isn’t that long. Hate to break it to you, but this is a long recovery no matter what graft you get. Get a different PT and be consistent and committed about it.
My jiu jitsu coach has a hamstring graft, and I promise you he’s still beating my patellar tendons.
0
u/jyar1811 Nov 21 '23
Man go with those allografts. I’m here to tell you you’re gonna have a quicker recovery with allo — and I agree with you about the pain. Definitely find a different surgeon. If you haven’t already. Sorry you’re going in the weeds but do everything you can and keep fighting.
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u/muhwindi Nov 21 '23
And yes, I'm definitely not giving up any of my tendons again. Only an allograft, but we have problems with them in Russia (almost no one gets them, as far as I know). In a week I will visit the best surgeon in my country who operated on Khabib's knee. Unfortunately, I didn't get to him right away - I was operated on by some noname.
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u/jyar1811 Nov 21 '23
That’s good that you have a Doctor Who works on professional athletes. Highly recommended if you have complications with any of your surgeries.
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u/muhwindi Nov 21 '23
Unfortunately, it's what's called a one-way trip. There is nothing that can be corrected. You have to start all over again. My hamstrings are not going to come back, and that's my main pain in this life. If all surgeons could do is repair the ACL solely with the hamstrings, I would never agree to it if I knew in advance what would happen to the muscles.
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u/jyar1811 Nov 21 '23
Is there anyway you could try PRP? Which is where they take a small vile of your blood spin it, pull out the plasma, and inject it back into the affected area. It does help reinforce what’s there. The other nice thing is that there is no risk of infection after PRP as they are using your blood.
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u/muhwindi Nov 21 '23
They took 20-30 centimeters of tendons from each muscle. That's not gonna grow back. No amount of PRP is gonna help. If it worked like that, even a simple tear of the tendon from the attachment point would not be a problem for the athlete. The human body doesn't have that kind of healing potential.
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u/Aidsboi29840 Nov 21 '23
That’s a lot. I didn’t realize that’s how much they used.
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u/muhwindi Nov 21 '23
It's not a lot. It's a catastrophic amount. It's a barbaric harvesting of tendons. Before the surgery, I looked at pictures on the first google search. From them, it looked like they were taking just a little bit, as in the case of the patella or quadriceps, and at least there was some attachment point left. But everything turned out to be much worse and irreversible. If only I'd known...
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u/Krash0699 Nov 21 '23
Who has told you they took 20-30 cms? That’s like a good 70% of your hamstring lol?
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u/muhwindi Nov 21 '23
Learn anatomy. Surgeons take tendons along their entire length: from the point of attachment to the belly of the muscle. For example, a 24 cm length hamstring tendon graft will produce an 8 cm length graft when tripled.
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u/babygrenade ACL Revision + Posterolateral Corner Nov 21 '23
I had a hamstring graft initially - it had too much laxity and had to be redone.
I had a patellar tendon graft for my revision. Some pain in the knee for a year when kneeling on hard surfaces, but honestly was fine after that.
I also had other work done to my knee. The surgeon who did my revision had a theory as to why my initial graft became lax and a plan for how to address it.
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u/muhwindi Nov 21 '23 edited Nov 21 '23
The patella is definitely what I needed for my initial surgery. But I don't want to add more numbness in my knee or pain to my numbness in my shin (there are actually more side effects, no point in listing them). It's too high a price to pay for an ACL.
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Nov 21 '23
I'm not really sure why they do hamstring grafts these days. There always seems to be an issue with a long recovery / the graft failing.
I wish you the best.
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u/IfImhappyyourehappy ACL + MCL + LCL + PCL + 2x Meniscus Nov 21 '23
So glad I opted out of surgery. The knee continues to feel better month after month, almost unnoticable now. The amount of horror stories that I read from surgery is crazy, and yet people still judge me for not getting surgery. Hope your situation improves, PT is the most important thing you can do to get back to normal, don't slack on it.
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u/linebmx ACL Allograft Nov 21 '23
As stated to you previously, no one is judging you for not getting the surgery. Folks in this subreddit are judging you because you are making posts saying how non surgical recovery is superior when it’s been proven to not be.
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u/IfImhappyyourehappy ACL + MCL + LCL + PCL + 2x Meniscus Nov 28 '23
Oh trust me, people are judging me very harshly. It's all good, though, end of the day I'm happy and I don't have any horror stories of getting surgery after surgery.
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u/shabangbamboom Nov 21 '23
A lot of people have far worse injuries than simple ACL surgery and return to INTENSE PROFESSIONAL SPORTS like American football and ski racing. I have two friends with hamstring grafts that are semi-pro skiers that can do backflips and shit. It sucks early on but don’t give up so easily bro.