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.
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?
Howard J. Luks, MD
You tell me :-)
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.
Howard J. Luks, MD
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
Howard J. Luks, MD
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.
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.
Howard J. Luks, MD
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.
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.
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
Howard J. Luks, MD
Dr Jeff Berg is a great Sports Doc in Northern VA.