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.
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
Howard J. Luks, MD
HI Ken … I’m glad it was useful !
I do not know anyone in that region .. sorry.
HJL
raul
Good morning Dr Luks is their any surgeon you would recommend in the wayne nj or Hackensack nj area. Thank You
Howard J. Luks, MD
HI Raul,
Sorry, I do not personally know of an Orthopedist in that area.
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?
Howard J. Luks, MD
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.
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!
Howard J. Luks, MD
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.
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
Howard J. Luks, MD
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