IMPORTANT – If you’ve had ACL surgery, please share your thoughts on these quick 9 questions… Share your ACL Surgery feedback

Valuable data is now being collected and results will be posted to the link above on Dec. 8th ! Too bad we didn’t have this info before having surgery!

Would 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

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.

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Learn about the decision of which graft to get: Patellar vs Hamstring
View the original ACL reconstruction surgery post…
Or, see another semi-gross picture of the knee.
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See valuable info from an ACL survey done December 2010…

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For ACL surgery, I have two reputable doctors with contradictory opinions. One says a patellar graft is best, the other says a hamstring graft is best. Online research suggests there’s no strong winner on either side, but perhaps a slight leaning towards the hamstring graft.

Doctor A says:

• Hamstring graft is the most popular choice for professional athletes today
• There’s less risk of graft complication
• No knee pain with hamstring graft, where as, the patellar commonly results in a lifetime of pain when kneeling
• Hamstring graft is stronger than the patellar, because of 4 dense strands bound together, instead of just 1 with the patellar
• Neither grafts ‘grow back’, so better to go with the hamstring, since it’s a very large size and taking such a small portion of it only results in a hardly detectable loss of strength 5% – 10%, but it’s easily regained through basic physical therapy
• The drilling hole in the bone can be smaller when using the hamstring graft, because of the efficient configuration of the 4 strands in the hole. A smaller hole, results in a stronger bone
• Patellar grafts can loosen/weaken the knee and lead to patella arthritis
• Patellar grafts are ‘old school’ – a thing of the past. This surgeon used these grafts years ago, but not since the advancements in hamstring grafts, which are now superior
• Tiger Woods had a hamstring graft
• Hamstring grafts are the best

Doctor B says:

• Patellar graft is a larger and stronger tendon that’s 10mm, instead of a 8mm hamstring graft
• Patellar graft is the most popular choice among athletes today
• An annual survey of hundreds of orthopedic surgeons shows that patellar grafts are most popular
• Patellars are the ideal size and length
• The hamstring is too small, too long, and requires a more technical procedure with greater opportunity for error
• The hamstring may stretch/loosen and may not fasten to the bone correctly over time
• The patellar actually grows back and regenerates itself in 8 months, where as, the hamstring will be gone forever and be noticeably weaker
• Tiger Woods only got a hamstring graft only because the surgeon he chose invented his own hamstring graft technique which he wanted to promote
• Patellar grafts are best

As you can see, there’s good reason to hesitate when making a choice with potential long-term health ramifications. Pardon me while I go flip a coin.

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IMPORTANT – Please fill out the 60 second ACL Feedback form – valuable data is now being collected and results will be posted on Dec. 8th !

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