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.
Do you have questions regarding an Orthopedic injury or longevity?
Do you want to talk to an expert who can listen to you for 45-60 minutes and explain the options in detail?
Dr. Howard Luks offers remote guidance sessions to review your X-ray or MRI images and explain your options.
Dr. Luks has also received hundreds of requests for educational sessions on the topics discussed in his book, Longevity Simplified.
Jennifer
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 ?
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
Sandra Watson
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.
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.
Joe
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?
Thanks!
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.
Aiqin Jiang
Dr. Luks, my 14-year old son tore his ACL about three weeks ago August 12, 2017. We got MRI results today. We will meet doctor on Tuesday and go over images and discuss options we have. After reading so much on ACL reconstruction, I wonder if it is wise to do the ACL reconstruction right away, or should wait until he stops growing. We live at upstate NY, Albany. I wonder if you know any surgeon you would recommend around here albany, NY. Any good advice would be very appreciated! sincerely, Aiqin
Hi…
Most of the research shows that children should be reconstructed sooner rather than later. The issues is that they do not curtail their activities. That puts them at risk for developing a secondary injury such as a meniscus tear, or injury to the articular cartilage.
I can not recommend anyone in that region…
Good Luck
Tammy
Dr. Luks, I am a 47 year old active female. I am a group fitness instructor and personal trainer and teach yoga and fitness classes at a university. Last year (June 2016) I tore my ACL while surfing. I saw a PT right after it happened and they seemed to believe that it was just a sprain so I went a couple of weeks before seeing my orthopedic doc back home. He ordered and MRI which revealed the complete tear and he performed surgery on August 5th using an allograft. My range of motion just wasn’t coming back which, in turn, delayed gaining my strength back as well. He was puzzled and the only thing he could think of was that it was arthrofibrosis. In November, 2016 he did a scope to scrape away excess scar tissue. Although it did help my flexion some, it made my extension worse. I am currently at about 7 degrees extension and 120 degrees of flexion after a whole year. I completed two rounds of physical therapy for a total of 4 months! I have consulted with an orthopedic specialist in Austin, Texas and am scheduled for another ACL reconstruction on August 15th which is fast approaching. My question is, I want to get back to being active (running, jumping, working out) – even at my age – would you recommend an allograft or an autograft? If an autograft – which type? I know it’s difficult for you to say without personally evaluating me. I just want to feel somewhat normal again! This is extremely frustrating. Any good advice you can give would be very appreciated!
These are really tricky cases… With the pain and trauma of a revision reconstruction I would be very nervous about you being able to get your ROM back. In these cases it is not unusual to manipulate, remove scar AND remove the old graft if its placement is causing an issue— and leave a revision for another day IF it is necessary. Many of these really stiff knees do fine without an ACL. I would get a few opinions on this if getting back your range of motion is your primary goal.
Stephanie
Hi, I was scheduled last Tuesday for an ACL reconstruction surgery using a donor. The day of the surgery, the doctor comes and and tells me he’s going to open me up and if it looks like like my body is “healing itself” he would just “clean up the damage” and not do the full surgery. This threw me off guard because it was my understanding I needed the surgery. The MRI reported I had an “ACL rupture near its femoral attachment” and that the “tibial fibers is low-lying within the intercondylar notch.” Is this normal for a surgeon to just not do the surgery? I didn’t think the ACL could heal itself. The doctor didn’t speak to me after the surgery, only my family and all he told them is that he saw that my muscle was already growing in place. My thing is won’t I still have knee instability? I can’t get the doctor on the line to tell me what’s going on. Should I be worried? Do I need to seek a second opinion?
YOu should seek another opinion…. ACL tears do not heal. We know before surgery if an ACL reconstruction will be needed. Your complaints, your examination and your MRI before surgery should be able to tell us what our plan should be.
raul
Good morning Dr Luks is their any surgeon you would recommend in the wayne nj or Hackensack nj area. Thank You
HI Raul,
Sorry, I do not personally know of an Orthopedist in that area.
ken sherman
Your website and articles have been very helpful to me, Dr. Luks. My MRI shows a partial tear of my left knee ACL. The posterior bundle is torn, but the anterior bundle is intact. Can you recommend a surgeon in the Rockville MD area skilled with partial tear augmentation surgery? I cannot find a surgeon who does this, and public information sources don’t include this information.
Best,
Ken
HI Ken … I’m glad it was useful !
I do not know anyone in that region .. sorry.
HJL
Srinivasa Pondugula
Hello Dr. Howard,
My 16 year old daughter tore her ACL on 10/01/2016. Doctor has recommended surgery after reviewing the MRI of left knee.
Here are the details of the MRI Report:
Exam Description: MRI Left Knee
History: Initial encounter for left knee pain after basketball injury 10/1/2016. ACL and medial meniscus injuries.
Technique: Multiplanar proton density and fat-suppressed. T2 sequences performed on a 3 Tesla scanner.
Comparison: None
Findings: Ligament: The (ACL) anterior cruciate ligament is ruptured in its mid portion. Posterior cruciate ligament is intact. There is mild edema about the proximal medial collateral ligament indicating sprain. Fibular collateral ligament and the popliteus tendon are intact.
Menisci: The medial and lateral menisci are intact. There is no meniscocapsular separation.
Osteochondral Structures: There are kissing contusions of the lateral aspect of the lateral femoral condyle and posterior aspect of the lateral tibial plateau. There is no fracture. Cartilage within the medial, lateral and patellofemoral compartments is preserved.
Exterior Mechanism: Intact
General: There is a small joint effusion.
Impression: The patient has undergone recent pivot shift injury with rupture of the anterior cruciate ligament and kissing contusions in the lateral femoral condyle and posterior aspect of the lateral tibial plateau. There is mild sprain of the proximal medial collateral ligament but no MCL tear. The Menisci are intact. There is no chondral Injury.
Please advise whether surgery is needed or not. If surgery is needed how to find a good surgeon in northern VA area ( 20148 zip code).
Thanks you,
Yours sincerely,
Srinivas
Dr Jeff Berg is a great Sports Doc in Northern VA.
Gretchen Donais
I’m between a rock and a hard place. My very athletic 15 year old volleyball playing daughter tore her ACL last week, mid season. Doctor did MRI and ACL is torn and slight tearing in the meniscus. The PCL, LCL and MCL are all intact. She’s supposed to have surgery in 3-4 weeks. He likes to do the repair with hamstring but I’ve had friend’s children use patella. There’s also the cadaver option. I’d like to know your thoughts on them and which would be the best to get her back on the court and hold and be able to compete at the next level and college in the future. Thank you for your time.
Sohail Khan
Hello Dr. Howard,
I am also suffering from an ACL injury.
My mri report says :-
1. Grade 3 bucket handle tear in the body and posterior horn of medial meniscus with flap of meniscus into intercondylar space anterior to PCL.
2. Complete ACL tear.
3. Mild to moderate joint effusion.
4. Grade 1 sprain of MCL.
I am in a doubt whether I go for surgery or not.
Please tell that should I go for it or go for physiotherapist for recovery.
Does ACL surgery be successful on this.
I don’t know much about it please guide me.
Please mail me as early as possible.
The bucket handle tear is the biggest problem. That needs to be reduced and sutured or stitched back into place. If you are ‘young’ do not have the piece removed. Whether or not the ACL needs to be reconstructed depends on whether or not you have instability.
Sasha
Dr. Howard, I am so glad I came across you website. Back in June 2014 I was playing soccer ( I am 45 years old). While trying to stop the ball in the air I have landed on my left leg and immediately felt sound like when you bite on potato chips coming from my left knee. At that moment there was only pain coming from the outer side of my left knee. I was able to walk to the side unassisted. There was no swelling in my knee and even next day I had a full range of motion.
I visited orthopedic surgeon 2 weeks after the injury. He performed physical manipulation on my knee to test for ACL tear and meniscus tear and came with conclusion that is possibly partial tear since minimal laxity has been felt. He than sent me for an MRI which came back with diagnosis of complete ACL tear, LCL sprain and meniscus tear.
He was as well as I shocked by the MRI findings and despite the fact that on the physical exam everything felt almost normal he recommended surgery. I was very mad that he didn’t even looked at the MRI pictures but only read the report. I did not agree with him and decided to go with physical therapy first. Today my knee feels great. I am able to run, play sports with my kid, run down the stairs without any instability symptoms. I did not try to go back to competitive soccer and probably will stay away from that.
I am wandering what do you think? Is it possible that an MRI can be incorrect?
Let me just mention that I had ACL reconstruction on my right knee 8 years ago, and at that time the injury was much more visible. My knee was swollen immediately after an injury and I could not fully bend and straighten my knee.
Sasha .. There is always a chance that an MRI is over-read. Or there is a chance that the ACL was partially torn and you are tolerating it well! Either way, I’m glad to hear you are doing well.
Kyla
Hello Dr. Luks,
I have a very similar situation in terms of Sasha’s immediate symptoms (except it was a hyperextension injury on a trampoline) and it also wasn’t diagnosed for weeks later . I’m almost 37 years old and have been suffering from a this injury since May 1st and, since my surgeon tore his bicep this summer, I’m not slotted to have surgery until mid-September. At this point I’m able to walk around, although prone to injury and pain since I’m a very active person. I’ve had various people, including a PT doctor, giving me advice not to have surgery at this point yet have not gotten an official second opinion from another Orthopedic Surgeon. My MRI is limited secondary to motion artifact (my leg flicked right near the end of the scan). It still reads that there is a complete or near complete tear of my ACL, Low-grade partial tear of proximal aspect of TCL yet other aspects are vague such as a meniscal tear. Should I get another MRI out of pocket, since my insurance won’t provide one? And how much is it worth having a second opinion given the fact that I won’t be able to afford a surgeon out of my network? Also, as someone who plans to be active the rest of my life, is the surgery necessary? Appreciate your feedback and all the work you’ve done to help people!
Thanks, Kyla
We reconstruct ACL tears in people who have instability because of their ACL tear. If you feel like the knee is buckling or it feels loose and unstable then it (surgery) might be the right thing to do. That’s really a discussion for you and your doctor. The physical examination matters more than the MRI. So if your doctor felt the ACL was torn from the exam then a repeat MRI study is possibly not needed.
So.. this is not a second opinion :-( I’m not allowed to do that. This is simply information to share with your surgeon when determining how you would like to proceed with regards to your ACL tear.
Wendy
I was supposed to have rotator cuff surgery (full thickness tear) this morning but cancelled late yesterday afternoon. It’s a very long story but his staff was rude and disrespectful to me when I asked questions and did not return my phone calls in a timely manner. They were disagreeable about the location for my surgery and had the audacity to tell me to find my own place for pre-op tests and have it send them the results. Several more issues arose as the day of my surgery approached. The last straw was when they refused to prescribe any post-op meds for pain because I’ve been in pain management. They insisted the pain management Dr. would prescribe my post op meds; I saw her yesterday and she refused, advising me that post op meds are the surgeon’s responsibility. His office said they wouldn’t prescribe anything without a release from pain management. I hurriedly arranged that, despite their protests, and they faxed the release to the surgeon’s office. I waited 30 minutes then called to ensure the surgeon’s office received it and was told they did not have it so I said fine, cancel my surgery. I’ve read that rotator cuff surgery is one of the most painful surgeries one can have yet the surgeon was unwilling to prescribe post op pain meds. Someone from his office called late yesterday afternoon, after business hours, to advise me they had the release. I thought about it for a minute and said no, it’s off. I’ve received nothing but grief and bad vibes from that office and decided to go with my gut. I found a board-certified orthopedic surgeon affiliated with a top notch clinic in OKC with whom I attended college decades ago. I have an appointment with his PA next week. I didn’t know this Dr. personally but we have mutual friends and I feel much better about having him perform my surgery. Did I do the right thing?
You tell me :-)