Dave’s ACL Diary: Doing it Solo

Prologue – Looking Back…

You’d like me to tell you that it will all be OK. That things will go great, and that you shouldn’t worry. If you’re like I was while prepping for my ACL recon, you’re seeing a lot of that. And things probably will go great for you. But in the end, they didn’t go great for me.

I’ve left my diary online because it’s popular, and I didn’t see an account of solo recovery from ACL surgery when I prepped for mine in 2000. The diary stops just before I became aware I was having trouble. Between PT, work and the extra time that travel takes when you’re on crutches, I just got busy and stopped around the end of February, 2000. There is good advice in there on planning and setting up your recovery space. Where I’ve recently annotated the diary, it’s highlighted like this.

What went wrong and why?

I chose the patellar allograft BTB procedure. Basically, you get a patellar tendon and bone chips from a cadaver, which is anchored into your knee and serves as a scaffold for your ACL to grow back. If I recall correctly, the donor tissue eventually gets absorbed, ideally after your ACL has re-grown. This is the why you can have donor tissue and not be on anti-rejection drugs for life. That’s my understanding of the situation anyway. I’m not an MD, and could be wrong.

One in four of the patellar allografts were expected to fail at the time I considered surgery. On the plus side, the doc doesn’t have to slice your leg way down to get your own patellar autograft tissue, nor does he have to pull a piece of your hamstring (and make you rehab your hamstring as well as everything else). Patellar allograft was supposed to be the fastest recovery and least painful of the ACL recon procedures.

And I just figured my luck would hold and I wouldn’t be the one out of four guys that had a failed patellar allograft recon. And I’m not sure of the particular cause of my failure.

Shortly after beginning weight-bearing walking (far, far later than most Orthopedic Surgeons would’ve had me walking), I could tell that something wasn’t right. I felt what seemed like bone-to-bone contact – something I’d never felt before. I mentioned it at every opportunity to my OS, but he told me to be patient and that it was nothing. After several months of asking, the OS finally sent me for a follow-up MRI.

Upon my appointment with the OS to discuss the results, the OS hadn’t bothered to get films, and had no report from the MRI center. He had the MRI center fax a report over, looked at the fax and said “You’re fine, they just can’t find it.” I said, “can I see that report?”. The report said (paraphrasing here) “It’s obvious that surgery has been done, but I can find no ACL nor any filament thereof”. So I consider that my OS lied to me outright about what the report said.

I immediately contacted the MRI center and asked about the quality of the MRI. The radiologist said the films were of high quality and appeared to show just what the report said. She offered to have a colleague take a second look. The colleague confirmed the same finding: Surgery, but no ACL in there. I was done.

I didn’t see that OS again, and resolved to find someone honest and good. As soon as I started mentioning I’d had this trouble, people all around me mentioned the same orthopedist’s name – a highly-regarded knee specialist in Atlanta. This doc didn’t want to take me on as a patient, and was concerned that I just wanted an opinion upon which to base a lawsuit. I’m not litigious by nature, and I had to relate my story and convince him I was only looking for an honest doc before he’d see me.

That doc got me fitted with a sports brace which I wear for hiking and backpacking, said he wouldn’t recommend a redo of my ACL. The sports brace works well, and would’ve been a cheaper and easier solution all around. Wouldn’t have taken most of a year to get back to where I was. Would’ve been exactly the same outcome or better.

A few things you should think about

You need to see a knee specialist to have your knee done. I made the mistake of going to an OS who’d fixed my thumb after a severe injury. Regardless of how well he did on the thumb, or what trust I had in him, he wasn’t a knee specialist. Someone who specializes in knees does tons of them, keeps up on the latest medical education on the topic, may even be an innovator in the field, but at least has had a lot of practice on the ACL recon, and knows what works for him.

Discuss with your potential OS her success rate on the ACL recon you’re being set up for (they vary by procedure, and by allograft/autograft tissue approach). Your surgeon probably knows EXACTLY how often she succeeds. If she won’t give you a figure, or an estimate, you’re probably not getting the straight story. Nobody has 100% successes.

Keep in mind that surgeons have enormous self-confidence, and this can turn into self-delusion. Make no mistake, it takes serious balls to decide you’re going to cut open a living human and make him better than he was before you started messing around in there. You WANT your surgeon to have a lot of confidence, but it’s also a reasonable request to get a report on his success rate with your procedure.

Discuss the course and duration of your treatment and rehab in detail before committing to a particular surgeon. Make sure you get a timeline, and that it’s realistic compared to other current reports of how long this procedure takes. My doc put me through a ridiculous bad, long non-weight-bearing routine that atrophied my leg and aggravated back pain I had going in. Make sure you can get a pain-buster (a Marcaine pump), and any other medication or durable medical equipment (DME) you need.

Find the best rehab center you can afford. You’ll be spending a lot of time there. Make sure it’s a center that communicates well with your doc. A lot gets lost between MD and PT when there’s poor communication.

Ask your potential OS when she had her most recent CME (continuing medical education) on your procedure. Make sure she’s up to date on the latest technique.

If you’re thinking about an allograft procedure (donor tissue from a cadaver), keep in mind that some providers in the industry have been cited for poor infection control – including a major provider operating in my state, at the time of my surgery, serving the hospital I was in. I can’t confirm that I got donor tissue from this company. Someone in Minnesota got infected tissue from this company and died of an infection a few days after routine ACL surgery. Keep in mind that this is a small, but REAL risk of allograft procedures.

I don’t blame my first OS for the failure of my ACL procedure. I don’t know enough about what happened to know it was his fault. But he did lie to me, and that was enough to chase me off. And if I’d known what kind of crazy rehab he’d have put me through, I’d never have chosen him to do the work.

I blame myself.

Look, you’re going to have someone cut holes in you while you’re out cold, risk injury, disease, maybe even death, or just coming away with nothing you paid and suffered for. You have to take responsibility for finding the right guy or girl to do the job as well as it can be done. No one will take this responsibility for you. You can’t coast through and assume it’ll go just fine.

I got wise to this by being stupid and not asking enough questions, not shopping around. You can get wise a little cheaper.

ACLs are by and large elective procedures. No one should be hurrying you to get yours done. Make a careful and considered choice. Get the best doc you can find. My insurance would’ve covered the best doc in town as well as it did the jamoke that I picked.

Find the best doc.

That said, if you’re considering recovering solo, read on for more mad science…