AJ Watch

[Untamed Snark]

I understand the sentiment there CTS, but no pressure in the decision at all - I only bought it to give it back to him, its only money...

If anything was slightly motivated by KT Tigers getting the tshirts printed for Goodes a few years back and wish I could have contributed to that too.

It's a beautiful gesture.
Your thoughtfulness made me smile.

[Hotpotato]

AJs journey with the Swans will always be part of its legendary history .
Good one Industrial !
That’s awesome .

[YvonneH]

When AJ receives his jumper from Industrial Fan I hope the Swans' website does a piece on it. Surely they would?

[chalbilto]

One would certainly hope so. I would be terribly disappointed if they didn't.

[goswannies]

I just had a thought. Apart from the LARS graft that he had, what other grafts has AJ had for his first 5 reconstructions?

[ugg]

He’s here at Spotless watching the NEAFL along with the other injured players Reid Amartey Pink Smith and Nick Blakey

[mcs]

Its not an investment, I'm giving it back to AJ

Champion work mate!

[goswannies]

.... aaaand getting back on track (because this thread is about AJ after all) .... I have a minor concern regarding AJ’s next recon. What autologous donor tissue does he have left to replace the most recent ACL?

We have 2 patella tendons and 2 hamstrings that can be used (ie each leg). There is also the ITB (though this is a little less popular.

LARS is an option (but the success is repeatedly questioned).

Or allograft - but given his history of infections, I’d be concerned about graft viability & rejection.

[stevoswan]

.... aaaand getting back on track (because this thread is about AJ after all)

......and anything associated with him......making Newman's reaction to AJ's injury and our opinions of it quite relevant.

Anyway, AJ wil do what he does and we will all find out in due course......but we can speculate and debate, this is what a thread is for.

[Ludwig]

.... aaaand getting back on track (because this thread is about AJ after all) .... I have a minor concern regarding AJ’s next recon. What autologous donor tissue does he have left to replace the most recent ACL?

We have 2 patella tendons and 2 hamstrings that can be used (ie each leg). There is also the ITB (though this is a little less popular.

LARS is an option (but the success is repeatedly questioned).

Or allograft - but given his history of infections, I’d be concerned about graft viability & rejection.

Doesn't the autologous tissue used in previous grafts regrow back to normal?

[goswannies]

Doesn't the autologous tissue used in previous grafts regrow back to normal?

Complicated answer sort of
Simple answer no

The patella tendon donor site will often have a palpable defect. Mine is 23 years old and I can still feel it. Scar tissue is often deposited in the region of the defect as part of the natural healing process (which is less elastic than tendonous tissue, and thus less viable as a donor tissue).

There have been instances where the middle third has been re-harvested for subsequent reconstructions. The potential complications are 1) weaker graft and 2) weaker donor site.

With the hamstring graft, the tendon is usually removed, (sometimes) doubled over to make it thicker to approximate the ACL and re-inserted in to the ACL position. This is a simplified explanation for experience, and variable depending on surgeon technique. There is evidence of tendon regrowth in some instances, but whether it is of the same quality of the original tissue is questionable. It certainly doesn’t always insert into the same spot (my second graft was a hamstring and the donor site it palpably different to my non-reconstructed leg). There have been instances of re-harvesting of the hamstring tendon too. Similar complications.

Often, they’ll go 1st patella or hamstring; then 2nd either the other (hamstring/patella) or the other leg (eg if a surgeon has a preference for the patella tendon, they might choose to use the patella tendon of the good leg rather than the hamstring of the same leg).
So there are 4 recons that can be done without re-harvesting or considering other options (LARS, ITB, allograft etc).

[Ludwig]

Complicated answer sort of
Simple answer no

The patella tendon donor site will often have a palpable defect. Mine is 23 years old and I can still feel it. Scar tissue is often deposited in the region of the defect as part of the natural healing process (which is less elastic than tendonous tissue, and thus less viable as a donor tissue).

There have been instances where the middle third has been re-harvested for subsequent reconstructions. The potential complications are 1) weaker graft and 2) weaker donor site.

With the hamstring graft, the tendon is usually removed, (sometimes) doubled over to make it thicker to approximate the ACL and re-inserted in to the ACL position. This is a simplified explanation for experience, and variable depending on surgeon technique. There is evidence of tendon regrowth in some instances, but whether it is of the same quality of the original tissue is questionable. It certainly doesn’t always insert into the same spot (my second graft was a hamstring and the donor site it palpably different to my non-reconstructed leg). There have been instances of re-harvesting of the hamstring tendon too. Similar complications.

Often, they’ll go 1st patella or hamstring; then 2nd either the other (hamstring/patella) or the other leg (eg if a surgeon has a preference for the patella tendon, they might choose to use the patella tendon of the good leg rather than the hamstring of the same leg).
So there are 4 recons that can be done without re-harvesting or considering other options (LARS, ITB, allograft etc).

I had a patella tendon autologous graft and had persistent patella tendinitis for about 5 years, but it eventually settled down. I've always wondered how football players could have an autologous graft like this given the stress on their bodies combined with the weakness in the donor site. Given that, the LARS or Allograft alternatives seemed to make sense, but it seems to have fallen out of favour. Julian Feller, who is the knee surgeon in vogue these days (and AJ's current surgeon as well) may only do autologous grafts, or at least is against doing LARS surgery, except for players with only a few years left on their normal playing careers. It seemed to work for Malceski though.

[goswannies]

I had a patella tendon autologous graft and had persistent patella tendinitis for about 5 years, but it eventually settled down. I've always wondered how football players could have an autologous graft like this given the stress on their bodies combined with the weakness in the donor site. Given that, the LARS or Allograft alternatives seemed to make sense, but it seems to have fallen out of favour. Julian Feller, who is the knee surgeon in vogue these days (and AJ's current surgeon as well) may only do autologous grafts, or at least is against doing LARS surgery, except for players with only a few years left on their normal playing careers. It seemed to work for Malceski though.

The advantage of allografts is the lack of donor site morbidity. The disadvantages include 4x the failure rate, same rehab time, graft rejection

With regard to Malceski, no one said they all fail. And the advantages of LARS include: shorter rehab time, no graft recovery, easier revisions. The trade off is higher failure rates. Potentially ok if you’re an elite athlete with a small career window. But the long term repercussions are also what surgeons need to consider. What is best for the person ... not the player.

With regards to the autogafts of your occupation, activity or style of play will come into play.

If you kneel a lot (eg carpet layers) patella tendon grafts will cause donor site issues. If your an athlete and you require quads power (powerful sprinters) patella tendon grafts can cause issues. Typically there shouldn’t be too much muscle power/strength loss in al well rehabilitated knee (professional athletes should rehab well), nor should the the donor site be compromised in the vast majority of instances.

[neilfws]

Looks like the boy is going around again. Best wishes to him.

https://www.instagram.com/p/Bmu-w-HgJzV/

[goswannies]

Looks like the boy is going around again. Best wishes to him.

https://www.instagram.com/p/Bmu-w-HgJzV/

He’s had a recon. Doesn’t necessarily mean he’s trying to play on. Just means he wants a stable knee

Whatever he & the club chooses, my best wishes to AJ for his recovery. He is an inspiration