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New ACL Injury. How to find Dr?

post #1 of 27
Thread Starter 
Found out today that the injury I suffered March 1 at Breckinridge is a complete ACL tear. Damn. It wasn't that bad a fall either. The weather was bad and the light flat, and I didn't realize how much speed I had picked up when my ski caught in crud on the side of the trail. I still swear that I didn't feel any pain until I had already fallen and was rotating around on my back with my head downhill. My theory is that the tail of my ski caught in the snow once I was on my back and twisted my knee. I dunno, and it probly doesn't matter. I didn't think it could be so serious since I was able to ski down the rest of the mtn. There is apparently even a small bone chip off the edge of the tibial plateau which the diagnosing dr. wasn't concerned about.

Can anyone recommend how to find a good surgeon? I'm 45 and in Maryland. I trust dr's about as much as autobody repairmen and am anxious as hell about submitting to one. Especially when I only know about as much about one as I might about a typical autobody repairman, lol. Maybe an ACL reconstruction isn't that big a deal with as many as are done these days, but I'm sure that it can be messed up just like anything.

Thanks
Mike
post #2 of 27
My wife and I have a good one, but he is in the Philly burbs.
post #3 of 27
Ask your regular/primary doc for suggestions.

The one thing I would suggest is finding out how many ACL reconstructions the surgeon does per year. You'd want one who does a lot and is up to date on the latest techniques. Use www.healthgrades.com -- for each doctor, they list the average number of surgeries of each type done per year.
post #4 of 27
Bummer.

That is exactly how I did mine in about 12 years ago, skiing a cat track in the fog, put one ski into a drift on the side, spun around and twisted the ski from the tail while on my back

I didn't think it was too bad, and the doctor told me I'd know in a few weeks if I needed and MRI. It got better and ten years later I found out I was missing that ACL.

My knee is really stable, and at my doc's advice (US Ski Team doc) I have not had it done. That is not the norm, so you probably should have it fixed.

I have several friends who rehab knees as PT's, and they tell me the difference in quality they see from one surgeon to the next is huge.

Then there is the hamstring, patellar tendon, or cadaver option to consider.

You need to find a good doc, one who is sports oriented, and then find another one to compare what they tell you.

Good luck, and sorry to hear about that.

Newf
post #5 of 27
Thread Starter 
Wow Newfy, I thought i was crazy for thinking that's how it happened. Interesting that the same thing happened to you. I've tried skiing on it twice so far and both times it's only stable up to a certain angle. If I try to turn aggressively requiring twisting the knee past a certain point it goes out. I can ski quietly and politely, but that's not a lot of fun...

That huge difference between surgeons scares the crap out of me! How is the average person supposed to know? I will look at the number done. When I asked the local dr. who did the diagnosis today how many he does he just said 'it is a very common surgery', so I wasn't very satisfied with that.
Mike
post #6 of 27
You might also want to peruse TGR's Gimp Central section. Lots of folks have had ACL recons done, and may be able to give you recommendations. Also, read up on ACL surgeries (both on the web in general and at TGR in particular) -- you'll find lots of different experiences for different folks, some good and some bad. That'll give you some ammo to ask questions of the surgeon.

For instance, if the surgeon says that you should keep the knee immobile for 1 month after surgery, that should set off some alarms -- current thinking (backed up by research) is that PT/rehab should start very quickly, and you should get the knee moving right away -- but some doctors may still be behind the curve.
post #7 of 27
You might even call the offices of Vail Summit Orthopaedics, or the Steadman Hawkins Clininc in Vail, to get a referral for your area... These guys seem to know who's who.
Another idea is to check with local pro teams and universities, and see who they use... I would choose a Dr who deals with athletes on a regular basis, over one who does not. They tend to be more aggressive in their ideas of rehab.
post #8 of 27
Quote:
Originally Posted by Velodog2 View Post
That huge difference between surgeons scares the crap out of me! How is the average person supposed to know? I will look at the number done.
Mike
Look at number done
Does the doc work with athletes, or mostly does geriatric hips?
Talk to the local physical therapists. They see the end results. You'll need a relationship with one anyway, might as well start now.

I can give you names in Bend, Oregon.
post #9 of 27
Quote:
Originally Posted by vail snopro View Post
You might even call the offices of Vail Summit Orthopaedics, or the Steadman Hawkins Clininc in Vail, to get a referral for your area... These guys seem to know who's who.
Another idea is to check with local pro teams and universities, and see who they use... I would choose a Dr who deals with athletes on a regular basis, over one who does not. They tend to be more aggressive in their ideas of rehab.
+1 to that. For my ACL last year I narrowed it down to three in my area (NYC); 2 from asking friends and work colleagues, and a 3d from a recommendation here on epicski. Ended up going w/no. 3 due to his extensive work with athletes (US ski and tennis teams, soccer players, and a local pro team). The other two had similar creds but for me the clincher was my guy had trained at Steadman Clinic in Vail for about ten years. Can't imagine anywhere they see more knees like yours, and more patients like you.

Also you might want to ask on this board - http://www.dcski.com/ubbthreads22/ubbthreads.php - for local options.

Last but not least: if you go the surgery route - get on it fast! I was not cleared to ski until six months after surgery. I know some who got cleared sooner, but for many it was six months. So if you want to be cleared for next fall you want to get it done ASAP. You may be advised to wait a bit for swelling to go down or to do "prehab" before surgery to help with recovery. If your surgery is in May or June, that gets you cleared by November or December. The longer you wait, the more of next season you lose.

Also fyi, here's some good background on ACL injuries and treatments - at the Steadman clinic website: http://www.steadman-hawkins.com/acl/overview.asp
post #10 of 27
Velodog2 -- I agree with the above responses -- these are all excellent suggestions.
post #11 of 27
Quote:
Originally Posted by ts01 View Post
Last but not least: if you go the surgery route - get on it fast! I was not cleared to ski until six months after surgery. I know some who got cleared sooner, but for many it was six months. So if you want to be cleared for next fall you want to get it done ASAP. You may be advised to wait a bit for swelling to go down or to do "prehab" before surgery to help with recovery. If your surgery is in May or June, that gets you cleared by November or December. The longer you wait, the more of next season you lose.
A word of caution on rushing to surgery. Most good surgeons will tell you that it's better to wait than to rush into an ACL surgery. My doc (who's very highly regarded here in the Denver area) told me that if I went under the knife without full ROM, there'd be a 20-30% chance of less than full recovery. He wanted me to wait until I got my ROM back and built up strength -- the stronger I go in, the stronger I'd return. So as ts01 mentioned, pre-op rehab is important.

It's still early, but I'd say he was right. Today is day 17 after surgery, and I'm walking without a crutch, doing the stationary bike, and feeling pretty good (full extension, 133 degrees of flexion).

From your original posts, I'd guess you probably have full ROM and everything, and would need much pre-op rehab.
post #12 of 27
Faisasy is right, your pre-surgery condition is likely to affect your recovery -- I didn't mean to suggest you rush in to surgery per se, just get the process going so you can be ready for surgery asap. I saw a PT 3x weekly and did the prescribed exercises daily for about two months before surgery. All I'm saying is I was surprised how much recovery time there was before I was cleared, and if you don't want to cut into next season you probably want to get focussed now.

Good luck - for what it's worth, my post-reconstruction knee is in great shape - after the first couple of days on it when I felt a little insecure I reached a point of equal or greater confidence in the reconstructed (and braced) knee than the healthy one. It's not only strong again but also all the PT work has helped with balance, quickness, confidence, and coordination so I think after the initial hesitation at the start of the season I may be a better skier due to the injury and rehab process than I was before. Not to recommend people get injured, just hang in there, the light at the end of this tunnel will not be a freight train.
post #13 of 27
Hospital for Special Surgery in NYC, Dr Riley Williams did my wife's ACL reconstruction. They are widely considered to be among the best if not the best in the business. It took about seven office visits in total from start to 1yr post opp. She is back sking and better than new. The total experience could not have been better (for a pretty major surgery that is). Just make sure you rehab hard no matter who does the surgery.
post #14 of 27
Quote:
Originally Posted by Cabinfever View Post
Just make sure you rehab hard no matter who does the surgery.
^^^ Wise words. I know your main concern right now is finding a good surgeon (as it should be), but it's almost as important to find a good physical therapist. Similar to the surgeon, you'll want a PT who has worked on ACL rehabs with athletes.
post #15 of 27
Quote:
Originally Posted by Velodog2 View Post
I had already fallen and was rotating around on my back with my head downhill.
Being in the backseat and sitting down during a fall is pretty much how all skiing ACL tears occur. If that is how one falls, an ACL tear is very likely in their future.

You should select a doc that specializes in knees and has a stellar reputation among medical pros. Nurses, PAs, PTs, know who the good docs are. However, docs will rarely opine about each other out of professional courtesy. If you don't know these people, drop into all the local PT clinics and say that you've heard great things about them, want to use them, and ask everyone which doc they'd personally use for an ACL repair.

If it were me, I'd come to Summit County and use John Gottlieb at Vail/Summit Ortho. He does about 300 knees (allograft) a year, many of which are not locals. His patients are weight-bearing on day one with no brace, and often no crutches. He is also very aggressive about getting patients back to normal activity. As soon as pain and swelling are gone and full motion is back, you're cleared. My wife was cleared to full activity, including skiing, in 3 months.
post #16 of 27
Thread Starter 
Thanks for all the responses so far folks. This is my first significant injury and I've got a lot of anxiety about everything involved, as I've already mentioned. Giving up control, especially of my body, to someone I don't know is extremely scary to me.

I am checking out the Vail clinics, that was a good idea. I also have an appt. to see a Dr. Klimkiewicz at Georgetown University Med Center who was recommended by a friend out here who was treated for this last year. This Dr. is the head of orthopedic surgery and sports medicine there. Sounds impressive, lol. I don't know if going someplace like that would be significantly more expensive than somewhere more ordinary - I will have to check with my insurance. It would be nice to go to Vail for the procedure, but I do not have a lot of funds or time off from work to do stuff like that, unless it was very clearly significantly better than any other option. It seems I should be able to find someone good in this area...

I have been researching the procedure a lot and feel like I have a good idea of what I would like done, but the dr. is the expert of course. It appears that the patellar autograft gives the best result (least stretch, good recovery time) although there is more post-surgical pain than other methods. Apparently placement of the graft is a big deal, with the most anatomically correct being best, and most difficult to achieve, and has a big bearing on function as well as longevity of the repair. Also aggressive PT with early mobilization appears to be good.

I have full ROM and no swelling now. There isn't a lot of pain either and I don't have any limp. A good dr. should be able to tell me if I'm ready or should wait. Damn, all this just to ski again, more or less. I'll feel better when the procedure is done and I'm recovering, I think, maybe.
Mike
post #17 of 27
Quote:
Originally Posted by Velodog2 View Post
Damn, all this just to ski again, more or less.
YMMV but in my five months post-injury, pre-op, other activities (i.e., running, cycling ) also were tough and the more I toughed it out, I did other direct damage to the knee (cartilage problems from running on an unstable leg) and probably risked more serious injury. My first ortho said the surgery was not at all necessary, so long as I stayed at my desk job 24/7. So the operation was not "just to ski again" but really it allows me to stay active. I wasn't ready to hang it up at age 44 ... surgery was a no-brainer.
post #18 of 27
Thread Starter 
yeah, I know you are right ts01. Unfortunately I guess skiing just happens to be more or less my only sport any more. I was a bicycle racer many years ago, but a back injury ended that. I lift weights now too, and have a shoulder injury that bothers me there. It just seems a little strange since the knee doesn't bother me very much in normal activities. It's easy to say I can just ignore this. I have other problems that bother me more day to day. But I know that wouldn't be smart in the long run. I do want to ski for a very long time. It's discouraging having this happen just as I was getting back into the sport after a layoff of several years, but I also remember thinking that I had totally forgotten just how incredibly fun skiing was when I started doing it again. I need fun in my life.
post #19 of 27
Some people can ignore it and do just fine. I blew mine at age 40, have skied, biked, played hockey, climbed rocks and mountains for 12 years without an ACL. My doc, a US ski team pool surgeon, says I have no cartilage damage and no arthritus, and should not have it done.

On the other hand, you might have one of those knees that really needs that ACL and will blow all your cartilage without it.
post #20 of 27
Velodog,
Many good suggestions so far. As for surgeon recs you could look into Union Memorial in Baltimore. They work with the Ravens as well as other teams/athletes. Steadman-Hawkins is THE place for Orthopedics so you obviously can't go wrong there. One doctor (Steadman or Hawkins) is in Vail and the other is located at another clinic in Greenville, SC I believe. At least that would be the same time zone.
post #21 of 27
Quote:
Originally Posted by newfydog View Post
Some people can ignore it and do just fine. I blew mine at age 40, have skied, biked, played hockey, climbed rocks and mountains for 12 years without an ACL. My doc, a US ski team pool surgeon, says I have no cartilage damage and no arthritus, and should not have it done.

On the other hand, you might have one of those knees that really needs that ACL and will blow all your cartilage without it.
Shouldn't that be the first thing to figure out? Whether the surgury is needed?

Velodog said he has no pain and full functionality of the knee. Maybe this is another case where the ACL isn't neccessary?
post #22 of 27
Thread Starter 
Quote:
Originally Posted by at_nyc View Post
Shouldn't that be the first thing to figure out? Whether the surgury is needed?

Velodog said he has no pain and full functionality of the knee. Maybe this is another case where the ACL isn't neccessary?
Well, I have not got a lot of pain, compared to other issues I have. And full range of motion. I can walk on it ok. However my experiences trying to ski on it indicate that I have maybe 70% capability there. It seems to give out once I reach a certain angle of twist, and then I fall and it hurts quite a lot. I imagine if I keep doing that, there will be additional damage. But hey, if the dr. tells me don't worry about it, I'm all about trying to avoid surgery.

I talked with the Steadman-Hawkins clinic in CO. and the woman there was very cooperative in giving me a couple of names of drs who have had fellowships there in this area. Almost like a salesperson, lol (?). I will call them on Monday. If I can get in to see one of them, it will likely come down to him (as they seem to be universally recommended here), or the Georgetown U. guy. Do want to get this thing moving and recovery started.

I suppose it theoretically could get more interesting as there were a couple of other things indicated on the MRI, namely the small tibial fracture, and some kind of inflammation that I can't recall the exact nature of, that the first dr. wasn't concerned about. They others could have a different opinion I suppose. But I'm not stressing about that.
Mike
post #23 of 27
Thread Starter 
Things are going about as well as can be hoped for now I guess. I have 2 appts on Friday, both in DC. One with the Georgetown U med center guy and another with a former Steadman-Hawkins Fellow named David Johnson. Hopefully having a former Fellow (ie having trained there) is as good as going there for surgery. I'm going to do a search on their records to see number of surgeries, etc. And am compiling a list of questions.

Oh, and almost forgot, my boss is out this week so missing most of the day Friday won't register on his radar. He's not the most supportive guy I could hope for.

Just wanted to bring you up to date and thank you again for the inputs.
Mike
post #24 of 27
Thread Starter 
Ok, doing a little research and found out that Dr Johnson, in addition to his work at Steadman-Hawkins, did his residency at the NYC Hospital for Special Surgery, and was also a Fellow Team Physician for the US Ski Team, Denver Broncos, and Colorado Rockies. Sounds good on paper. Gee, I hope I like the guy...

Also, the one thing the first dr. was somewhat concerned about due to possible effects on recover is a bone marrow edema in the tibia, which is apparently like a trauma-induced bruise/swelling. Never heard of such a thing.
Mike
post #25 of 27
Getting an edema/blood clot in the lower leg is probably one of the biggest risks of ACL recons from what I've heard.

During surgery prep, they put TED hoses on both legs, which I was supposed to keep on for 4 days -- the compression helps prevent the formation of blood clots.

I also took a baby aspirin once a day for it.

Plus, the doc prescribed some exercises starting the day after surgery (mostly ankle rotation) to help.
post #26 of 27
Quote:
Originally Posted by Velodog2 View Post
Ok, doing a little research and found out that Dr Johnson, in addition to his work at Steadman-Hawkins, did his residency at the NYC Hospital for Special Surgery, and was also a Fellow Team Physician for the US Ski Team,
It seems there are a lot of those ski team pool guys around. I've dealt with them in Denver and Bend, and they always seem to be top notch. Sounds like the guy to go to. Good luck

Newf
post #27 of 27
Thread Starter 
Just an update. I have actually chosen the Georgetown U. guy after much consideration. After seeing both of them, he personally just gave me a much more confident feeling. A factor turned out to be the support behind him of the Georgetown U Med Center - all very organized and professional. Also, he does a lot of the surgeries (around 18/month) and has a great reputation throughout the area.

I'm sure the other guy with the great resume would have been fine also, but he is in the process of changing offices (he is opening his own sports injuries clinic). That's fine considering that I didn't like the organization he was with as the examining room was actually dirty (scary - there was dried blood on a box of gauze pads...). As a result it would have been his first surgery at his new hospital, and information I needed was just written on scraps of paper, etc. Although his scheduler assured me he was very good, she was for some reason unable to give me information on how often he performed that surgery more specific than 'a lot', even when pressed. Just too much anxiety with this guy - but it was still difficult to decide. I may go back to this one once he gets his clinic open for my rotator cuff problems - his other specialty...

I had a choice of cadaver or the patellar autograft and I chose the autograft because recovery is 2 months quicker and I've read that the result is a little stronger/tighter. The post-surgical pain is supposedly greater, but pain is forgotten quickly. He emphasized aggressive PT and has ordered a continuous passive motion machine for the recovery. And the important thing is that he said I'd be able to ski in 4 mos. I'm scheduled for June 14.
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