Surgeons

There is an important link between ACL surgical options and orthopedic surgeons, and it is this – while they may be competent with multiple techniques, each doctor has his or her own surgical preferences. These preferences can be determined by many factors including personal experience, initial and ongoing education, medical study results, associations with medical distributors, insurance company requirements and limitations, group practices, and the specifics of the patient and their injury. I believe that all doctors are inherently good people but it is worth noting that not all of the aforementioned factors are necessarily based on the best interest of the patient. The doctors I met with all said something like, “typically in a case like yours I use…” and then they went on to describe their recommended surgical specifics.

Choosing a surgeon is a very difficult and personal thing. I sent a request for ACL surgeon recommendations to the cycling email aliases at work and within two days I had a list of 27 names. Some were known for treating high profile pro-sports athletes. One had performed numerous surgical repairs to Barry Bonds and was now under investigation for potential ties to the steroid mess. Some were in private practice, some belonged to groups. I sorted and evaluated them based on duplicate recommendations and the quality of their websites. Not exactly ideal criteria. In the end, I identified a small number of comparible details, most requiring entirely subjective assessment, and from there I made a list of five doctors.

It took about three weeks to get out to see all five doctors. Based on their collective comments, it seemed that I had a pretty typical ACL case, although there was a higher degree of collateral damage than they normally see. They all performed essentially the same physical exam and all agreed with the MRI Findings Report, the complete summary of which is as follows:
1.) Complete tear of the ACL near the femoral attachment
2.) Grade II MCL sprain, Grade I/II LCL sprain
3.) Sprain of the short head bicep muscle and vastrus lateralis muscle
4.) Suspect tear of the lateral patellar retinaculum
5.) Joint effusion with superomedial patella plica

Each of the doctors I saw had their own specific method and approach. The breakdown was as follows:
Graft Source: Allograft (5)
Tissue Type: Tibialis tendon (4), Patellar tendon (1)
Attachment Method: Transverse suspension (3), Endobutton (1), Interference screw (for use with bone-patellar-bone graft) (1)
Hardware: Bioresorbable (5) [note: the endobutton itself is titanium]

All of the doctors wanted nearly full range of motion in the knee and little or no swelling prior to surgery. They all would perform the surgery as outpatient (no overnight) either in a local hospital or surgery center. Only two required x-rays, and only two recommended pre-op physical therapy (PT). My feelings on those last two items helped me narrow the field. If there were another six ways to image the knee, I’d want them all. And if PT helps get the knee prepared for the surgery and subsequent recovery, then why would you not do it?

The last doctor I saw was Kevin Stone in San Francisco. Initially I was drawn to him because he was performing repairs of the native ACL, but after talking with him about it I decided against that approach. His extensive involvement in orthopedic research and the dozens of patents he holds for surgical tools and methods are convincing indications of his overwhelming commitment and competency. Finally, I was so impressed by the level of professionalism and compassion that he and the entire staff displayed that I could hardly imagine going anywhere else. He was geographically inconvenient, but still well within reach. He was “out of network” as they say in the insurance game, but I could cover the additional cost.

And so surgery was scheduled. February 5th.

He would use the bone-patellar-bone allograft. A slight donor source variation on the “gold standard” of ACL reconstruction methods. This is not to say that newer soft tissue graft methods are less successful, in fact there are plenty of studies that show that they have equivalent results. The BPB method, however, is the most common and in many respects the most straight forward approach. It seemed to me that having doctor Stone perform this operation would be a bit like getting Michelangelo to draw me a happy face. But then, why not. At least I was confident it would be a good one.