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Advice Mar 11, 2014

What does an ACL really cost? The financial and intangible costs to players and families

WendyLeBolt-HeaderAuthor note: Part I of 2 part article. Next Up — Balancing the Books: Effective ACL Prevention Is the Job of Every Coach

I cautioned Katherine about the incidence of ACL injuries in athletic girls whose knees tended to fold inwards when they jumped and landed as hers did. The 8th grade basketball and lacrosse phenom was unconcerned.

“Don’t worry,” she told her Dad, “If I tear my ACL, I’ll just get it fixed.” To her, an ACL repair was a simple trip to the orthopedist who would set things right and send her on her way. She had no idea of the complexity, the carpentry, the trauma and the recovery involved in the reconstruction of a knee with a torn ACL. Her Dad knew better; he was a physician.

I work regularly with athletes battling back from this injury, through its repair and associated recovery and rehab. There is a huge physical, mental, emotional and financial cost. Just how big? Let’s see.

Experts estimate that each year there are at least 100,000 individuals in the U.S. who suffer a new injury to the anterior cruciate ligament of the knee. Primarily, these are young healthy individuals who are engaged in sporting activities involving sudden cutting and twisting movements like football, soccer, basketball and skiing. Soccer players are particularly susceptible to the non-contact version of the ACL tear, resulting from a twisting of the knee as the leg straightens.

So, how much does this surgery cost? A family in Maryland knows all too well. Eve, their teen daughter, has had two and Max, their young adult son, has just endured his third. For their daughter’s most recent surgery, this was the tab:

The surgery itself (which also included some meniscus repair) was billed at $38,217.25

Assistant billed at $3,018

Anesthesia billed at ~ $2,000

Radiological Services (MRIs) billed at $2,140

Medical Supplies (braces, crutches) $650

Leg machine billed at $850

All together, the procedure and associated supplies and support services = $46,700

Now add: Therapy visits: 4 @ $120, 15 @ $160 = $2,880

For a whopping total of nearly 50K.

So, if we estimate (conservatively) there are 100,000 repairs per year in this country, the financial cost is nearing the 5 billion dollar mark. This is a huge burden on our health care system. And, of course, insurance doesn’t cover it all. The family in Maryland and one in Virginia whose daughter is still rehabbing both estimate their out of pocket expenses at $4-6,000, and warn that this could be more depending on when these expenses fall in the billing cycle of your health insurance. Both families are quick to tell me that spending the extra dollars on well-qualified physical therapy and specialized training for return to play is essential. It is so time consuming, though, that one Mom wondered out loud whether her daughter could put physical therapy on her college applications as an extra-curricular activity.

The dollars spent alone are frightening, but they’re just dollars. What about the intangible costs? This burden is huge and hard to quantify. I am greatly indebted to these two families who were brave enough to dig out the paperwork and respond by phone and email in an attempt to address this question.

Dollars may speak, but what these parents had to say stopped me in my tracks. “When she said she felt pops and her knee cap felt slidey I knew but didn’t tell her, ” the Maryland Mom said. “Your heart just sinks. The second time it happened, I could tell from her face that she thought it happened again. She knew.”

Youth players take part in a FASA-National Guard clinic in Fredericksburg, Va. on Aug. 11, 2013.The Virginia Dad recounts the moment their “hopes of a rock star soccer player were dashed.” He uses words like “stunned, shock, grief.” And then he waxes analytical as he calculates the costs: time lost for his daughter at school, with activities and friends, and to his family in lost time from work, transportation time and fuel cost. His opening comment on the spread sheet: ‘ground zero’ hints at the enormity of the upheaval. The cost: staggering.

Janet, the Maryland Mom, makes me smile when she says they “did not suffer from lack of family time.” In fact they had more because they were stuck at home and she had to drive them everywhere. They needed help with everything, and she did not want to leave them home alone until they were moving better and undrugged because they could not have left the house in an emergency. In a family where both parents worked outside the home, the expense in time off from work to make these accommodations was yet another cost to be absorbed.

But we do this as parents. We have no choice; they’re our kids. We’ve just watched in horror as they’ve crumpled in pain. The joy of the game one moment turns to complete despair the next. Opportunity and dreams are instantly replaced by appointments, grueling rehab, waning confidence, isolation, depression and more. For these two girls, soccer was their life. Now they were in a battle to regain it.

Jane (not her real name), 15 at the time of the injury, recalls the moment as a tangling of two players which caused her to land wrong and her knee to give out. “I got my surgery and started physical therapy. The first two months were the worst. I remember coming home from surgery and looking at the exercises I was told to do post-op. I think it was three sets of ten leg lifts. I started to try and lift my leg, but it wouldn’t even budge. That was the first time in my life where I have ever just physically NOT been able to do something. It’s awful.”

“I was forced to give up soccer, which is the hardest thing I’ve ever done. I’ve played soccer for half of my life, and it’s what I love. Having to sit there and watch my team move on without me and get scouted by colleges that should have been seeing me play was devastating.”

Eve, 14 and 15 at the time of her two ACLs, says the first was a plant and twist injury, the second involved an interaction with another player which twisted the knee. Amazingly she emails, “I told myself I had one day to mope and be miserable. After that I knew I couldn’t change anything so I just had to accept it.” She admits the cost was high. “I had to give up many months of doing what I loved: soccer. I also gave up a lot of my social life, especially after surgery. There were a lot of times my friends would want to hang out but I couldn’t because I had to go to physical therapy, or my crutches prevented me from doing what they wanted to. I gave up a lot of hours for my summer job because of all the training I had to do. I had always wanted to play lacrosse or run track in high school in the spring but there’s no chance of that anymore.”

What would you say to other players and their families about this injury? I asked. Jane sounded much older than her 16 years when she advised, “It’s so easy to go to the gym and do preventative work outs. Strengthen your hips, strengthen your hamstring, your quads. If you’re wearing cleats, get cleats with circle studs, not blades. Generally, just put in the work before hand so that you don’t have to deal with the life changing repercussions.”

Eve is matter of fact. “I would just tell them that it’s not fun and it’s not easy but they’ll get through it. They should definitely get the best therapy possible. And don’t rush no matter how much pressure there is. It’s definitely tough to feel like you’re missing out, but it’s better to take your time the first round then have to go back for another.”

Don’t let this happen to you is the message that rings loud and clear. Eve, now fully rehabbed and having returned to play for her club and school team, says, “I do feel much better, but playing soccer now is different and I’m not sure if it will ever be the same. I have to be a little more cautious and there’ll always be a part of me that’s a little nervous knowing that there’s a risk every time I step on the soccer field. I didn’t have that before.”

Jane is still recovering and rehabbing. “Five months in and I’m running and just got cleared for cutting. It feels like there’s more hope now for me getting back to soccer, whereas at the beginning I felt stranded, like I was in a tunnel with no light at the end. I’m definitely getting closer and I can see improvement. Now my high school season has started and I’m watching two teams, my club and high school, continue on. I know I’ll get there soon, but it’s still incredibly hard to watch.” Powerful words from a 16 year old who is watching from the bench as her teammates pull away along their path to her dream.

We, as a soccer community, owe it to Jane and to Eve and their families to do all we can to prevent this injury. In fact, we can’t afford not to. As MasterCard would say:

ACL Surgical expenses: $50,000

ACL Injury Prevention so they never have to travel this road again: Priceless

Next Up —  Balancing the Books: Effective ACL Prevention Is the Job of Every Coach. I’ll propose a new and simple recommendation for every coach who is invested in making ACL injury prevention part of his or her game plan.