Did you know the majority of Orthopedic Surgeons perform only a handful of ACL reconstructions a year? Usually less than one per month. Does that matter? There are some surgeons who may perform 15-20 operations a day? Are they better?
ACL tears are increasing at an alarming rate. Most children require an ACL reconstruction to restore stability and minimize the risk of further damage to the meniscus or the other ligaments in the knee.
Adults are staying active longer and pushing themselves harder. Adults are also tearing their anterior cruciate ligaments more frequently. Many adults are also choosing to proceed with ACL surgery as opposed to altering their lifestyle. They are on the move and have no desire to slow down.
Decision making after an ACL injury is not always straightforward. In a previous post, I helped you by supplying you with a number of questions to ask your doctor to help determine if ACL surgery would potentially benefit you. We went on and explored the options you have regarding graft choices and other ACL surgical issues.
Now you have torn your ACL and you have chosen to have ACL surgery.
Which surgeon should perform your surgery?
Key Considerations in Choosing Your ACL Surgeon
- Training: Are they a Sports Medicine Specialist. In other words, did they pursue advanced training in the management of ACL injuries? Sports Medicine trained Orthopedic Surgeons went through an additional year of training to hone their skills at minimally invasive surgery and reconstruction of the ligaments around the knee.
- Affability: Sounds simple… but do you trust them? What is that voice in the back of your head saying? You probably shouldn’t stay with a surgeon you do not trust. If something goes awry you will never forgive yourself -–or them.
- Education: Did your surgeon take the time to educate you and/or your child about ACL injuries, your options available and the procedures available to repair the damage? Has the surgeon returned your phone calls? Do you have their email address? Have they responded? If you have trouble reaching your surgeon before surgery… that difficulty might increase drastically after surgery should an issue arise.
- Volume: Volume matters. As I mentioned before, most Orthopedic Surgeons perform very, very few ACL reconstructions. It has been shown that an ACL Surgery performed by a low-volume surgeon leaves you at a higher risk of complications and failure. Look for a surgeon who performs a few ACL surgeries a week. That means that they likely possess the technical skills to put the new ACL in properly and in a reasonable timeframe, which improves your chances of success. Now… what about a very high volume hospital or surgeon. Do you think one surgeon stays with you throughout the entire case if they have 20 other cases on the board that day? Nope. Very high volume surgeons utilize physician extenders, residents, etc to help them power through a busy day. I personally do not believe that is the proper recipe for success either.
There are many decisions that come into play when you have suffered an ACL injury. You need to decide whether or not you need surgery, which graft you want to use to reconstruct your new ligament from, and you need to choose a qualified surgeon to perform the procedure.
Hopefully, this provides you with some useful guidance as you begin your search for the surgeon to perform your ACL Surgery.
Hey Doc, great article…thanks!
Curious on your opinion on my case: 40 yr old active & healthy male with an unhappy triad from a motocross accident. Will have meniscus repaired and figure rather have my knee cut once versus twice in the event had knee instability from no ACL. What are your thoughts on best graft choice for me? I mountain bike, ski, ride dirt bikes and like to live an active lifestyle.
Oh, and any chance you know any great surgeons in the Pennsylvania area?
Howard J. Luks, MD says
Thanks Joe …
Many graft should work well for you… quadriceps, patella tendon or hamstring. They each have their advantages and disadvantages. I can’t firmly recommend one vs the other without talking with you. Many good sports docs in Phili (Silo, and others) and Pittsburgh (Harner, Fu) area. I’m sure there are many more docs in small towns who are experienced at ACL surgery that I simply do not know.
Sandra Watson says
Our daughter tore her ACL when she was 12 years old and underwent a Hamstring Surgery since she is quite active in soccer and swim, and this surgery wouldn’t interfere with her growth. She healed well and strong and returned to soccer after a year of rehab.
Everything was fine until this las January 26th she was on a HS soccer game and heard a pop. She is now 16 years old. We contacted her Orthopedic Surgeon and MRIs were done, and they came back advising that the Hamstring grafts had ruptured and there was ACL tear. She will be undergoing an ACL Revision Surgery using the Quadricep Tendon. We are nervous and want to hear your opinion on this graft over the patellar. Our daughter wants to continue to play competitively and enjoy an active life in Highschool, in college and well into her adult life, and we want to make sure she has this choice. We are devastated and want her to get the best surgery to bring her back stronger. We are just full of doubt and fear as this will be her second surgery within 4 years. We thank you for your time.
Howard J. Luks, MD says
I’m sorry to hear that! The statistics surrounding ACL injuries are troubling. Children under 12 with an ACL tear have a 20% chance of rupturing their other ACL or the new ACL graft. ACL prevention techniques like the FIFA 11 program work well… but never bring the risk down to zero.
ANyway… revision ACL reconstructions can be tricky. As long as there is no “tunnel widening” or other issues to contend with then both the quadriceps and the patella present themselves as very good graft choices. Over the last few years the data on Quad tendon reconstructions has been very positive.
Good luck !!! Please consider implementing the ACL prevention program once her rehab is finished this time.
My 13 year old son hurt his knee at basketball camp yesterday. The trainer feels it may possibly be an ACL injury. Since he is still young and dealing with growth plates. Would you recommend Scottish Rite as a first choice ?
Howard J. Luks, MD says
There are many sports doc who feel comfortable with open growth plate ACL issues. I do not know the docs at Scottish Rite. Many parents end up going for a few different opinions. Start there… good luck