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Resources Sep 17, 2013

Who’s doing your ACL?

Editor’s note: This is the latest blog post from Dr. Wendy Lebolt, a longtime coach and physiologist who is the founder of Fit2Finish, a Northern Virginia-based training, fitness and rehabilitation company which works with teams and individual players to maximize health and performance. The Soccer Wire is excited to present Wendy’s learned perspectives on the mental, physical and psychological aspects of the beautiful game. Learn more about her background here.

Did you hear that NFL star Robert Griffin III had knee surgery? Good grief. They even prepared an animated look at ACL reconstruction for the Monday Night Football audience watching the Washington vs. Philadelphia game last week.

Of course, it was all cleaned up. No blood or gore. Not the sounds of drills or hammers or screws or suction. But, in real life and real knees, it’s carpentry work and that’s messy. No wonder the RGIII of games one and two has looked more like RG2. By the 4th quarter, maybe RG2½.

When the pros tear their ACLs, who do they turn to? Celebrity athletes head straight for Dr. James Andrews, surgeon of the stars. Why? Because he’s been repairing torn ligaments for a long time and not just knees: shoulders and elbows, too. How did I know? I looked him up on Wikipedia. Bet you didn’t know he was a Southeastern Conference champion in pole vaulting.

You can get a lot of info online these days, including reviews of restaurants, travel locations, services, hotels, airlines. You can also get reviews of physicians’ groups, sometimes of individual docs. But they tend to be about “the experience” of seeing this doctor: bedside manner, willingness to answer questions, competence of office staff, ease of follow up, physical therapy recommendations, etc. All good. But if you’re looking at surgery, don’t just trust the online reviews. You want to know more.

Like, how are his hands? Even though this looks like carpentry, you want the hands of the cabinetmaker. How careful is he to get that graft to be exactly anatomically correct? The slightest deviation will make the movement at that joint different, leaving it stiffer and more prone to early arthritis. Plus, many ACL-injured knees have additional injuries to meniscus, joint cartilage or collateral ligaments. Joint repair is an art as well as a science.

This is some of what you’ll find online

“ACL injury has an annual incidence of more than 200,000 cases with about 100,000 of these knees reconstructed annually. The majority of ACL injuries (about 70 percent) occur while playing agility sports and the most often reported sports are basketball, soccer, skiing and football. An estimated 70 percent of ACL injuries are sustained through non-contact mechanisms, while the remaining 30 percent result from direct contact…

“More ACL injury cases occur in males due to greater numbers of male sports participants; however females have a higher risk of being injured. NCAA statistics found that female athletes are 2-8 times more likely to sustain an ACL injury playing sports.”

Approximately 50 percent of ACL injuries occur with injuries to other structures in the knee. The meniscus (50 percent of multi-structure injuries), medial collateral ligament (30 percent), or articular cartilage (30 percent) are the most frequently concurrently-injured structures.

If you want to know more than population statistics you have to do your homework, then ask the right questions and the right people.

1. Talk to the prospective surgeon. Ask:

  • How many ACL reconstructions have you performed?
  • How long have you been doing them?
  • What type of graft do you recommend? (auto or allo, hamstring, patellar or cadaver?)
  • What is the recovery and rehab like?
  • Can I get back to playing? When?

2. Talk to athletes (and their families) who have had this surgery. Ask:

  • Would they recommend their surgeon? Why? Why not?
  • What was recovery and rehab like?
  • Did you have complications?
  • What was recovery time? rehab plan?
  • Did they return to play?

3. Talk to physical therapists who work with kids after surgery. They may be the best resources of all, because they see the handiwork of the various surgeons. Ask:

  • Who has the cleanest surgery (least swelling, fewer infections, quickest recoveries)?
  • Which surgeons are up on the latest procedures?
  • What procedure(s)have you seen work well?
  • Does it matter if it’s a male or female knee?
  • A re-tear or a pristine knee?
  • What should I be prepared to face in my recovery and rehab?

And that, according to the PTs I work with, is at least as important as a good surgeon: being dedicated and compliant in rehabilitation. They’ll tell you that especially teens and young adults are in a hurry to get back in action. They start feeling better and they want to get back at it. Be patient. Let it heal. Let the bone heal and the ACL strengthen. Be prepared for a 9 month to 1 year battle, or longer. It’s an endurance event. It requires perseverance and patience. It is “Operation Patience,” as RGIII coined it, even though it cost him a fine for being out of uniform.

Prepare to be slow at first. Quickness, agility, body sense – these are the last things to come back. Your brain has to be re-connected to coordinating those movements, too. You’re not just learning to walk again. You’re learning to play again. Remember RG 2½.

It would be nice if knees didn’t get injured. Even specialized injury prevention training can’t prevent them all. If your athlete goes down with one, get the best in the business to do the repair. To find them, I wouldn’t just trust online reviews. Wikipedia is good for trivia. This is not trivial.

Do your homework. Then ask other athletes, trainers and therapists for their advice. Once you decide, be prepared to do battle and wear the operation patience t-shirt. You want this ACL to last not only your whole playing career, but your whole life.

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