Tag Archives: acl surgery

Quarterback Robert Griffin III Underwent ACL Surgery

Quarterback of the Washington Redskins, Robert Griffin III,  had undergone ACL surgery to repair the anterior cruciate ligament yesterday morning (1-9-2013) as well as repair a lateral collateral ligament in his right knee. Knee surgeries are technical surgeries that require months of rehabilitation and it is likely this may affect the 2013 season for the high-performance football player.

Griffin had torn his ACL previously in 2009 while playing at Baylor and is hopeful this time it will be a stronger, longer-lasting outcome.

Choosing the Right Knee Brace for ACL Surgery Patients

ACL injury from football is very common
ACL injuries from football are very common

The patients who opt for surgery are required to wear knee braces after surgery temporarily to provide support to the knee and helps in regaining the lost strength. But some former ACL surgery patients have chosen to continue using a knee brace for athletics, even after they have 100% recovered. According to the survey conducted by aclsurgery.us of 187 ACL surgery patients, 31% (58) said they still wear a brace, though they’ve fully recovered. 33% (62) said they sometimes wear a brace, and 36% (67) said they never use a brace. This means that approximately 2/3 of the people who have had ACL surgery still feel they need for a brace. And with the variety of braces in the market, how does one choose?

Knee Brace Survey
Knee Brace Survey

Different types of knee braces are specially made to suit the needs to ACL surgery patients. However, the best and the most widely recommended one is the braces with hinges and metal supports. The hinged knee brace covers the major portion of the leg i.e. from the portion above the knee to middle of the calf. It is specially designed to provide comfort to the injured ligaments as well as to prevent strain on those parts during the movement.

Some of the companies who specialize in the manufacturing of knee braces for ACL surgery patients are Donjoy, Breg, McDavid, Ossur, ProCare, etc. Out of these, Donjoy is the most popular as well as widely used brand for ACL braces. There are many models available in each of the above-mentioned brands and the price varies from brand to brand and model to model.

We will compare two knee braces: Donjoy Custom Defiance knee brace, and Breg custom LPR ligament knee brace which are specially meant for ACL surgery patients.

Donjoy Custom defiance knee brace:

Pros

  • It offers maximum comfort to the injured ligaments due to its custom fit feature.
  • Over 40 different choices in colors and graphics.
  • Mechanism to control the flexing and extension of the knee.
  • Manufactured by most trusted and widely used brand.
  • Wide range of supporting accessories.

Cons

  • Higher price than competing brands

 

Breg Custom LPR ligament knee brace:

Pros

  • It is designed with light weighted aerospace aluminum in order to stabilize injured ligaments.
  • Provides great protection as well as comfort to the knee.
  • Comes with airframe padding, which allows the moisture and heat to move away from the skin.

Cons

  • Absence of Mechanism to control flexing and extension.

Even though it is listed at $950 it can be availed at a special price of $759 from braceshop.com.

You can also find many affordable braces on following websites:-

  • braceshop.com,
  • betterbraces.com,
  • dme-direct.com, etc

While you can save money ordering online, it comes at a risk, however, as it may not fit as precisely as you want. And the fit is key to protecting your knee and avoiding future injury. So, the best way to buy the right knee brace is to try on different braces in order to determine the comfort and support abilities of each brace. This is best done in a major metropolitan area where you can drive to a variety of brace carriers. It may take a little effort, time and money in travelling around to find the best brace for your knee, but if protecting your knee is a high priority, it may be a wise investment.

ACL Surgery Successes and Failures

Wrestling ACL SurgeryMany athletic people and professional athletes sustain a painful injury to the Anterior Cruciate Ligament of their knee and have several options for rehabilitation including surgery choices. If the patient is not intending to return to athletics and wants to commit to physical therapy options and doesn’t want surgery, it is possible to regain use of the knee again for normal living. However, the majority of patients want full use of their knee to return, will not consider a life without action and sports and therefore choose surgical repair. The most common sports to cause ACL injuries are: Soccer 23.5%, skating 13.7% and basketball and football both at 11.8%.

There are three primary choices of grafts for ACL surgeries: patellar grafts, hamstring grafts, and allografts (cadaver grafts). There is much speculation and debate about which graft and fixation is the best. Surveys show that the hamstring graft is the most popular choice currently for most people, but that the most serious athletes in competitive sports still choose patellar grafts, known for being the strongest, most reliable graft, but not necessarily the most pain-free.

The best advice before surgery is to wait at least six months to allow the swelling to abate, with full range of motion to return and pre-surgical strengthening exercises preparing the way. After surgery, the need to work with a physical therapist and/or athletic trainer is crucial. It will also take a full year for the proprioception to return which is the balance and agility factor, so important to keep from re-injuring the knee.

Out of 400,000 ACL surgeries a year, about 18,000 to 35,000 (4% to 9%) fail is some way. The most common failures are permanent stiffness; lack of full extension and range of motion; instability and a pain and/or grinding. The reasons for failure include going back to sports too soon; not completing proper post-operative care with a brace or cast; and several possible surgical errors. The graft may have been misplaced, non-anatomically correct, too vertical or too tight. The rehabilitation program may have been poorly designed or the patient had lack of motivation to succeed. Whatever the reason, the condition is called “arthrofibrosis” and this failure will lead to post-traumatic arthritis.

Some patients had successful surgeries and rehabilitations, but end up reinjuring the knee either playing the same sport that caused the original injury or from other activities involving twisting motions of the knee. Whether through carelessness or by accident, the resulting knee injuries will be more complicated, less stable, and require even longer rehabilitation. Most professional athletes are forced to retire after reoccurring knee injuries.

Choosing a Doctor for ACL Surgery

Choosing a Doctor for ACL SurgeryChoosing your doctor (the surgeon) for your ACL surgery is in important step in the process. It can be overwhelming trying to decide who you should put your trust (and money) in for this once-in-a-lifetime (we hope) surgical procedure. You will likely work hard in pre and post-rehab and the last thing you want to do is choose some bozo doctor who is inexperienced and does a mediocre job. There are horror stories out there and you don’t want that to be you! You only have one set of knees and you want them to last for your lifetime. So, how do you decide who to choose? I assume you live near a city that has a variety of doctors to choose from. So, assuming you have a large pool to select from, the most important step is narrowing it down to the right person. Below are a few ways you can narrow down the prospects.

Narrow down by graft or fixation type
Doctors tend to have distinct areas of expertise and tend to do procedures they’re comfortable with. It’s uncommon for a surgeon to perform both patellar grafts and hamstring grafts, for example, it’s normally one or the other. So, when you choose your doctor, it essentially decides what type of graft and fixation technique. Therefore, it’s best to make sure you have already chosen what graft you want first. This will then narrow down prospective surgeons.

Narrow down by location
Another way to narrow it down is by location. How important is it that you have the surgery as close to where you live as possible? On surgery day, you’ll need to have someone drop you off and give you a ride back. It may not be feasible for some to drive 2 hours or more to a big city. So, this may limit the pool of surgeons as well.

Narrow down by expertise
You can narrow surgeons down by expertise as well. Make sure they are board certified with the state and have all the normal credentials. Maybe the surgeon has a few feathers in his cap from special research or techniques he or she has pioneered. Some people want reputable surgeons that are on-staff surgeon for a professional or college sports team. Pro sports teams likely would do extensive research and choose only the best surgeon for their team, so you could piggyback off their selection criteria.

Narrow down by reputation (websites)
Another option is to search for a doctor’s reputation online. Several sites exist, but there are none that are 100% adopted by everyone yet. You probably want to avoid sites like angieslist that require payment upfront and have no guarantee of any kind of useful content. The best site for the time being seems to be: http://www.healthgrades.com Go there, type in a doctor’s name and see if it has any info.

Narrow down by choosing ‘preferred providers’
Your health insurance company may have a preferred providers list on its website that are guaranteed to successfully process payments through your insurance company. This is an important step as you don’t want to risk having the surgery and find out the provider is ‘out of network’ because of some technicality, forcing you to spend thousands more dollars.

Hopefully this list helps you fine tune your list of candidates for performing your ACL surgery. If you have additional criteria that helped you decide, please share below in the comments.

Remove Screws After ACL Surgery?

remove screws acl surgeryHas anyone had their hardware removed (screws, etc) after having ACL surgery?

I’m currently scheduled to have my 2 titanium screws removed from my my incision, just below my knee. It isn’t the bioabsorbable screw, as that is not wise to remove, being deep into the bone. The surface area with the 2 screws is sensitive, but is only minor pain- probably a 2 on a 10 point scale. With my insurance deductible met, I’m tempted to have the screws removed, but I don’t want unnecessary risk.

Read more about Removing Screws

Advice from my ACL Surgery

knee-braceWould you like to learn from someone else’s knee surgery experience? This is a summary of what I learned through my ACL surgery (which took place in February of 2009):

  • Yoga is an excellent way to build strength and balance prior to surgery- something that I reaped the benefits of post-surgery, because there’s a lot of hobbling around in crutches and balancing on one leg while reaching down and picking up things
  • Wait a while before the surgery. It took 6 months for my swelling in my knee to go completely down where I regained most of my motion back and was able to do strength exercises. The surgery is said to be more successful after all the swelling subsides. Just be careful in the mean time to not reinjure yourself, and it will be worth the wait.
  • Ice machines are good if you have people around to help maintain it. They run out of ice quite often, every 1-2 hours. So, unless you have people helping you with it, you won’t get much rest constantly getting up to fill the machine with new ice and drain out the old. Crushed ice is worst, regular size ice is mediocre. The longest lasting is homemade ice in 16oz cups- denser- and still fits in container- it may last 3-4 hours each batch. There’s also an electrical shock hazard on the Game Ready ice machine I had. Water from the drainage may leak onto the AC outlet underneath. What were the product designers thinking?
  • Try to avoid hopping on one leg with the other one dangling within a week after surgery. I suspect this and other extra movements led to me having some extra pain and internal bleeding- which they had to manually drain with a needle 1.5 weeks post-surgery.
  • A wheelchair is not a bad idea, as an alternative to get around in your home.
  • For rehab, it’s better to listen to your body (pain level) and let that dictate the speed of recovery rather than follow a physical therapist’s recovery timeframe to a T. It’s ok to take the exercises slow- there’s no rush.
  • It’s nice to have a cart on wheels. One that’s not tippy. You can put dinner plates on it, and roll items from the refrigerator to the table, or for moving your heavy ice machine around, etc. Otherwise, it’s a challenge moving objects around the house with crutches.
  • Don’t try to touch toes to put on/off socks- I may have pulled my hamstring doing that.
  • Don’t pay your bills too soon! Wait until absolutely everything is resolved between your providers and insurance company first. You don’t want to start paying bills you don’t owe. There’s a degree of negotiation between the provider and insurance company and it’s best to postpone paying until everything is settled and knowing that you’re not getting jipped- it puts you in a better position to negotiate in case your insurance didn’t cover something they were supposed to.

Post ACL Surgery Timeframes:

  • Same day: went home and used crutches to get around
  • 1.5 weeks – stopped using the ice machine full time, much of the swelling gone
  • 2.5 weeks – started driving (very carefully) and went completely off pain pills.
  • 3 weeks – less dependent on the knee brace- went without it- and start walking.
  • 3.5 weeks – able to climb/descent stairs
  • 4 weeks – started walking without crutches, able to use stationary bike and do light squats

Insurance companies will harass you and will try to find any loophole possible to not cover your benefits. As tedious as it is, it’s best to speak to the billing department of each of your service providers in advance and get price quotes and take good notes with who you spoke to, dates, billing codes, time spent on each procedure, etc. Then speak to the insurance company and ask them based on this scenario what your coverage will be. They are trained to be extremely vague about everything, so it takes some work. Take detailed notes on everything.

How much does ACL surgery cost?

I got a couple quotes (before insurance coverage) and here’s the range…

Surgeon fee – $1,350 – $2,200
Facility fee – $810 – $9,300 (huge range!)
Anesthesia – $748 – $845
Implant fee – $500

Other fees:
Full knee brace – $490
Ice machine rental (2 weeks) – $300 (not covered by insurance)
Prescription pain medicine – $100
Crutches – $30

Get more info on ACL Surgery Costs

If you are having a hard time with the cost aspect of ACL surgery, there’s nothing wrong with shopping around and choosing a different doctor. You can even travel to a larger metro area if its important enough.

Insurance issues

My insurance is supposed to cover 80%, but with the deductible, 20%, and some things not covered, when it’s all done it’s supposed to be $2,000 – $3,000 to me. That’s a little too vague of a price range for my comfort, but that’s part of the billing game.

It’s 5 weeks out and my insurance company is playing the game, saying initially that my benefits are denied, while requesting an ‘incident report’ form to be filled out. Basically, they’re trying every possible scenario to get out of paying, fishing for someone else to be potentially liable for the incident. I think they’ll have to pay though, according to the conditions of the plan.

Provider issues

The providers are also a little tricky in the way they bill. For example, they quoted me only the surgeon’s fee each time I asked about billing with no mention of any other weird fees. But now that it’s over, they decided to bill separately for one of the assistant’s time too. I would have wanted him out of the room if it were up to me- it would have saved $490.

The providers also quoted me one rate and billed another- higher $ of course. They also said the prices will be going up after the new year, which may be reflected in my bill. There’s really no guarantees of anything and the patient is in a very poor position for negotiation.

I hope this information helps someone. I wish I had this kind of info beforehand.

Remember to also read everything on this site and read the ACL surgery tips and comments from other people.

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Learn about the decision of which graft to get: Patellar vs Hamstring

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Patellar vs Hamstring

Patella vs Hamstring for ACL sugeryChoosing between patella vs hamstring as a graft for ACL surgery can be a difficult decision. At a glance the options seem fairly balanced, with pros and cons on either side, but our two polls have shown a slight leaning toward hamstring graft. Below is what people commonly say among the choices:

Read more about Patella vs Hamstring