Latest / The ACL Athlete Podcast / 208 | Should You Get A Second Opinion For ACL Surgery?

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208 | Should You Get A Second Opinion For ACL Surgery? · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ATL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and hope you guys are having a good day today.
• 1:06
  SPEAKER_00: It is the start of the new year, or we are some weeks into January, if you will.
• 1:12
  SPEAKER_00: And if there are any of you who started some New Year's resolutions or some goals, this is your friendly reminder.
• 1:18
  SPEAKER_00: Revisit those, especially because life just life's right.
• 1:23
  SPEAKER_00: And so we want to get back on track.
• 1:25
  SPEAKER_00: And so this is just as much a reminder for me as it is for you guys, but especially for our ACLers as we get into this process.
• 1:33
  SPEAKER_00: I know we always go super hard at the start of the year, especially.
• 1:37
  SPEAKER_00: And then therefore, life gets in the way.
• 1:40
  SPEAKER_00: So with that said, I hope you guys are doing well.
• 1:43
  SPEAKER_00: Good start to the year.
• 1:44
  SPEAKER_00: Let's do the thing and get into the episode for today.
• 1:48
  SPEAKER_00: So, what we're talking about today that I am excited about is around second opinions.
• 1:55
  SPEAKER_00: And I get this question a lot.
• 1:57
  SPEAKER_00: Should I get a second opinion?
• 1:58
  SPEAKER_00: Should I get a second opinion for my surgeon?
• 2:01
  SPEAKER_00: Should I get a second opinion about what this non-operative ortho said about my knee?
• 2:06
  SPEAKER_00: Should I get a second opinion of my physical therapy?
• 2:10
  SPEAKER_00: Although the first place that we usually think about this is the surgical opinion, right?
• 2:16
  SPEAKER_00: Because it's such a major thing that is done.
• 2:19
  SPEAKER_00: It's a more permanent thing, if you will, that is actually changing the structure of this knee and the ACL.
• 2:26
  SPEAKER_00: And it's one of the big decisions that you make through the ACL rehab process, right?
• 2:30
  SPEAKER_00: It's picking your surgeon and then picking your physical therapist and rehab professional.
• 2:37
  SPEAKER_00: Now, what we commonly see is that people will, you know, co in and they will see the orthopedic surgeon and they will get some type of recommendation, right?
• 2:50
  SPEAKER_00: Usually it's to have surgery in most instances if there's a torn ACL.
• 2:54
  SPEAKER_00: And then you have certain ones that are a little bit more open and are like, you know, based on your goals and your tear, you might not need surgery, right?
• 3:03
  SPEAKER_00: But it is far and few between.
• 3:05
  SPEAKER_00: And I say this because this is just the nature of their work.
• 3:10
  SPEAKER_00: And the bias is typically to do surgery over not having surgery, right?
• 3:16
  SPEAKER_00: And it makes sense because most of the time for ACL, it is more warranted to have surgery based on the current evidence.
• 3:22
  SPEAKER_00: So there's no knock against this, but the bias in the lens look through is does this person need surgery or not?
• 3:28
  SPEAKER_00: And oftentimes that bias can kind of persuade things.
• 3:32
  SPEAKER_00: Now, with that said, we are assuming that surgery is needed.
• 3:37
  SPEAKER_00: And so then, therefore, we are trying to figure out some thoughts around this.
• 3:42
  SPEAKER_00: And in terms of picking the surgeon themselves, you know, we've had podcast episodes about this in the past, but what we will commonly see is that people will either just kind of Google and find someone randomly, maybe they have some good reviews, which is great.
• 3:58
  SPEAKER_00: Go check them out.
• 4:00
  SPEAKER_00: Or a lot of times they will find the surgeon and they are the pro team surgeon or the college team surgeon.
• 4:08
  SPEAKER_00: And the thing about surgeons is that they're smart.
• 4:12
  SPEAKER_00: They went to medical school and they went to residency and fellowship.
• 4:16
  SPEAKER_00: Like they're smart people, right?
• 4:19
  SPEAKER_00: And so they're gonna sound smart.
• 4:20
  SPEAKER_00: It's also a very confident profession.
• 4:24
  SPEAKER_00: I have not met a single surgeon that is timid in my entire life.
• 4:28
  SPEAKER_00: So take this for what it's worth of when you go to meet a surgeon, they're going to have a certain level of confidence.
• 4:35
  SPEAKER_00: There is going to be this level of like, this is what you need to do.
• 4:38
  SPEAKER_00: And honestly, it's great.
• 4:39
  SPEAKER_00: It's it's great to have that advice that is very direct.
• 4:43
  SPEAKER_00: And a lot of these surgeons will have the conversation with you, but then there's also a lot that are just like, this is what's going to be done.
• 4:51
  SPEAKER_00: And here you go.
• 4:53
  SPEAKER_00: Here's the surgery date.
• 4:54
  SPEAKER_00: We literally just had someone who signed up working with us and was like, I literally went into the surgeon.
• 4:59
  SPEAKER_00: They said, This is the graph you're getting, schedule the date, see you later.
• 5:02
  SPEAKER_00: There was nothing really talked about, any options.
• 5:05
  SPEAKER_00: What does the timing look like?
• 5:07
  SPEAKER_00: It was just this very transactional approach, which is challenging in the healthcare space in general, right?
• 5:13
  SPEAKER_00: I think we see A plus B equals C.
• 5:15
  SPEAKER_00: If we're seeing a lot of volume of people, we kind of have these algorithms of the way that we operate as human beings of like, okay, yeah, if this person's coming in as a young athlete toward their ACL, they're probably going to get a quad tendon because that's what I do.
• 5:27
  SPEAKER_00: And we move forward and schedule the surgery as soon as possible.
• 5:32
  SPEAKER_00: Now, that is just some context for you guys.
• 5:35
  SPEAKER_00: And I'm just sharing this based on what I know in the space, what I've experienced.
• 5:39
  SPEAKER_00: And I talk to countless ACLers who are going through this process day in and day out.
• 5:44
  SPEAKER_00: And it's more of this than it's not.
• 5:46
  SPEAKER_00: So, my goal with this podcast is always to prepare you guys.
• 5:51
  SPEAKER_00: And I'm not saying that there is all bad, there are amazing surgeons and medical professionals that I work with, our team works with, and are all over the world.
• 5:59
  SPEAKER_00: But there's also a lot of bad ones or ones that just kind of move through this process like a mill.
• 6:05
  SPEAKER_00: And so we need to make sure we're doing our due diligence here.
• 6:09
  SPEAKER_00: So the reason I am bringing this up is because we're talking about second opinions.
• 6:14
  SPEAKER_00: And I always say to people, especially when they are new in this process, even if they've had multiple tears or experience, even if you're a PT who is so knowledgeable about ACLs, right?
• 6:26
  SPEAKER_00: Get another opinion.
• 6:27
  SPEAKER_00: Don't just go to one, get another opinion.
• 6:30
  SPEAKER_00: And I say the same thing about a physical therapist too, right?
• 6:33
  SPEAKER_00: You don't want to just go to the PT clinic down the road because it checks the box.
• 6:37
  SPEAKER_00: Like, we need to make sure that we vet the person and make sure we vet the clinic and vet the surgeon, if you will, no matter the status or no matter the referral, if you will.
• 6:50
  SPEAKER_00: And the thing is, is that even coming back to PT, even people come to us, I will say, you know, if this is not the best fit for you, I will tell them because sometimes we are not based on the remote or in-person components.
• 7:04
  SPEAKER_00: And so that is something that is important for me to stress to people because maybe they do need something in person and it's in another country, or it's, you know, a 12-year-old female athlete whose torn or ACL has never lifted in her entire life, and she might need a little bit more in-person day in and day out support, right?
• 7:24
  SPEAKER_00: So it's important to know where these limits are.
• 7:28
  SPEAKER_00: And I think that's where getting other opinions can be helpful because it is businesses at the end of the day, too.
• 7:35
  SPEAKER_00: And so then they will kind of tell you what you want to hear a little bit more than if it is truly right for you sometimes.
• 7:41
  SPEAKER_00: Now, when you're looking to vet them, I think sometimes it's important, you know, going back to the pro team surgeon or the college team surgeon, you know, they're the best because they have this accolade.
• 7:54
  SPEAKER_00: In reality, I think sometimes the quality can get lost at times because they do get lost in the sauce, if you will.
• 8:02
  SPEAKER_00: And maybe they forget about the person.
• 8:03
  SPEAKER_00: They're just so in it.
• 8:05
  SPEAKER_00: They've been, you know, climbing this ladder or they've established this like status or this accolade.
• 8:10
  SPEAKER_00: And sometimes they almost lose the actual humanizing in-person aspect to it and it's more transactional.
• 8:16
  SPEAKER_00: Yeah, they may be good, they may be smart, but maybe there is also another surgeon or another professional that might be better fit for you in your situation, right?
• 8:26
  SPEAKER_00: So these are things to factor in in terms of when you are thinking about a surgeon, or honestly, this goes across any medical professional.
• 8:36
  SPEAKER_00: And the other thing I want to mention here is just choosing based on convenience.
• 8:41
  SPEAKER_00: I'd rather have the better surgeon that is two hours, three hours away versus the one that's 10 minutes away, right?
• 8:49
  SPEAKER_00: And this is important, y'all.
• 8:51
  SPEAKER_00: It's a very, very important decision of who's gonna do this surgery and who also is gonna do your rehab.
• 8:56
  SPEAKER_00: It's the two most important decisions you are going to make in this ACL rehab process.
• 9:00
  SPEAKER_00: I promise you.
• 9:02
  SPEAKER_00: And with that said, the two-hour away surgeon, if they're better, it's gonna be worth it because guess what?
• 9:09
  SPEAKER_00: You are not gonna be seeing them super often.
• 9:11
  SPEAKER_00: You might see them every, you know, eight weeks, 12 weeks.
• 9:16
  SPEAKER_00: It's like uh usually it's like a three-month cadence in terms of post-op process.
• 9:21
  SPEAKER_00: So three months, six months, nine months.
• 9:23
  SPEAKER_00: That's what a lot of surgeons here do.
• 9:25
  SPEAKER_00: So even if they're two hours away, you could probably budge with that every three months, right?
• 9:30
  SPEAKER_00: Even post-op, even if the surgery is a little bit further away, pick the person who is right for you versus what is convenient.
• 9:36
  SPEAKER_00: So that's gonna be super important.
• 9:38
  SPEAKER_00: And now I want to kind of like bring this around to highlight some important scenarios where people search for options and pick the best, not settling for the first available or convenience, which is what I often see in this ACEL rehab process.
• 9:54
  SPEAKER_00: And I just don't really fully understand it, but I do because I went through this and we went to a surgeon, and yeah, they were good.
• 10:02
  SPEAKER_00: They told me what I wanted to hear.
• 10:04
  SPEAKER_00: They're like, here's what we're gonna do, and we check the box, right?
• 10:07
  SPEAKER_00: And so this is always challenging because we don't know what we don't know.
• 10:11
  SPEAKER_00: But when you're listening to this podcast, I'm hoping that you are able to know a little bit more.
• 10:16
  SPEAKER_00: And so when we think about searching for options and picking best, not selling for first available, think about these scenarios.
• 10:24
  SPEAKER_00: If you are this person, right?
• 10:27
  SPEAKER_00: You are someone looking to buy a house.
• 10:29
  SPEAKER_00: Would you buy the first house you see?
• 10:33
  SPEAKER_00: You're gonna have heart surgery, something that is literally life or death, right?
• 10:37
  SPEAKER_00: Heart surgery.
• 10:38
  SPEAKER_00: Would you find the closest cardiovascular surgeon and pick them?
• 10:42
  SPEAKER_00: You're going to college.
• 10:44
  SPEAKER_00: Would you pick the first school who accepts you?
• 10:47
  SPEAKER_00: And if you're someone who is in college or beyond college, like think about this.
• 10:51
  SPEAKER_00: Did you just literally pick one college?
• 10:53
  SPEAKER_00: They accepted you, and I'm good?
• 10:55
  SPEAKER_00: Or did you actually kind of look around at different colleges, even though you didn't necessarily apply to them or anything like that?
• 11:01
  SPEAKER_00: Or did you just have one and done and that was it?
• 11:05
  SPEAKER_00: You're going to purchase a computer.
• 11:07
  SPEAKER_00: Would you buy the first one that came up on Google if you were Googling for a computer?
• 11:12
  SPEAKER_00: What about a phone?
• 11:13
  SPEAKER_00: What about any other object that we buy?
• 11:17
  SPEAKER_00: Right.
• 11:17
  SPEAKER_00: So this kind of provides some context of human logic and what we do in these situations of okay, if I'm going to do this thing, buy a house, go to college, you know, purchase a computer.
• 11:29
  SPEAKER_00: You think about parents whenever they're trying to pick schools for their kids, um, and trying to understand that.
• 11:35
  SPEAKER_00: Like sometimes they'll move to different places, sometimes they will take kids to private school.
• 11:40
  SPEAKER_00: There are a lot of things that dictate a lot of the output you're going to get from it.
• 11:46
  SPEAKER_00: And so, therefore, we try to make sure we shop around, if you will, or get opinions and figure out what is the best.
• 11:53
  SPEAKER_00: It's the same thing we do on Amazon or any other website at this point.
• 11:57
  SPEAKER_00: We look at reviews, we see what's good, and we see what people's opinions are about it before we make a purchase.
• 12:04
  SPEAKER_00: And so this is something that's super, super important here.
• 12:07
  SPEAKER_00: And I'm not saying that you may find the surgeon who is awesome, you've talked to a lot of different people, and they have incredible reviews, then maybe you don't need to go anywhere else, especially if you jive with them and the game plan sounds amazing.
• 12:21
  SPEAKER_00: You've done your homework.
• 12:23
  SPEAKER_00: But a lot of times what I see is that people come into this and they end up just going with the first surgeon, book this surgery, and then they move forward.
• 12:33
  SPEAKER_00: And the thing that I want to kind of flip on you here is instead of you being in this scenario about getting surgery, it's the human you care about the most.
• 12:41
  SPEAKER_00: It might be your mom, your dad, your sister, brother, son, daughter, best friend, husband, wife, whoever that might be.
• 12:47
  SPEAKER_00: They're the ones going through these scenarios.
• 12:50
  SPEAKER_00: What would your advice to them be if they picked the first option, the cheapest option, or maybe the most convenient, right?
• 12:59
  SPEAKER_00: You probably push back a little bit.
• 13:01
  SPEAKER_00: You probably say it's worth the investment.
• 13:04
  SPEAKER_00: Find the right insert blank surgeon, physical therapist, coach, mental health professional, right?
• 13:12
  SPEAKER_00: You're going to say find the right person for you, especially if it's something major like a house, heart surgery, college, or even a computer or a phone.
• 13:21
  SPEAKER_00: That being a little bit more materialistic, you're still gonna maybe try to find the right thing, right?
• 13:27
  SPEAKER_00: So, why do we allow ourselves to do this?
• 13:30
  SPEAKER_00: I get it.
• 13:31
  SPEAKER_00: Don't get me wrong.
• 13:32
  SPEAKER_00: We don't know what we don't know, as I was saying earlier.
• 13:34
  SPEAKER_00: So, majority of people will go into the ortho.
• 13:37
  SPEAKER_00: They will sound confident, they'll get the surgery scheduled, they'll say, hey, this is the graph type.
• 13:43
  SPEAKER_00: And then they'll typically recommend PT, whether that is just like a paper with a list of clinics, maybe they have a partnership or internal one, and basically says, you know, just choose one that accepts their insurance.
• 14:00
  SPEAKER_00: And this would be awesome if all surgeons, physical therapists, coaches, and insurances, all healthcare was created equal.
• 14:13
  SPEAKER_00: But you guys know very, very much from this podcast and your own personal experiences, I'm sure it's not.
• 14:20
  SPEAKER_00: It's very far from it.
• 14:21
  SPEAKER_00: And there's nothing quote unquote perfect out there, except maybe like Chick-fil-A sandwiches and their customer service, which are pretty consistent across the board.
• 14:30
  SPEAKER_00: This is the reality of healthcare in our medical system.
• 14:33
  SPEAKER_00: I know I talk about this a lot on this podcast, but you guys, it's a big deal.
• 14:39
  SPEAKER_00: It's the difference in a re-injury, scholarships, careers, dreams.
• 14:46
  SPEAKER_00: And you guys think I'm kidding, but you would be so shocked at the number of calls and the number of people I've talked to, and my own personal experiences, honestly, that this stuff has literally ended people being physically active.
• 14:59
  SPEAKER_00: They're like, I don't care to run anymore, I don't care to go play with my friends, I don't care to play soccer ever again, I don't care to ever go hike again or ski again because this was so terrifying.
• 15:10
  SPEAKER_00: And it might have been the second time it happened or the third time, and it completely ended things that they are obsessed with.
• 15:17
  SPEAKER_00: And some of you listening are probably like, yeah, I can relate to this.
• 15:21
  SPEAKER_00: Other things like spiraling with your mental health, your financials, it's a big deal and it's a big difference in the financials.
• 15:28
  SPEAKER_00: Think about how much this ACL injury costs, especially here in the States.
• 15:32
  SPEAKER_00: It's insane.
• 15:33
  SPEAKER_00: Think about the day-to-day function, the long-term outcomes like osteoarthritis and total knee replacements.
• 15:40
  SPEAKER_00: I don't want to sugarcoat anything, but when you have an ACL injury, you have a little bit more of an increased risk of osteoarthritis.
• 15:48
  SPEAKER_00: And especially with a meniscus uh involvement as well.
• 15:51
  SPEAKER_00: And so, with that said, you want to make sure that you are set up as much as possible for a surgeon who is going to set you up for success and physical therapists and rehab professionals who are going to make sure you're set up for success so you can avoid a total knee replacement and be able to push this off as much as you can or avoid it in total, right?
• 16:10
  SPEAKER_00: Most importantly, it's getting back to what you love, what makes you you.
• 16:15
  SPEAKER_00: I experienced this personally and have talked with hundreds and hundreds of ACLers at this point who have experienced this.
• 16:22
  SPEAKER_00: And to make this real for you guys, I want to read this text from a friend who recently tore his ACL and is trying to schedule surgery.
• 16:29
  SPEAKER_00: He sent me a text and was like, is there any way I can get an earlier appointment with a certain surgeon here?
• 16:37
  SPEAKER_00: And the text goes on to say the initial appointment with him isn't until a few weeks from now, and I want to try and get the surgery around that time to get to recovery faster.
• 16:48
  SPEAKER_00: I've already had an initial surgical consult at another surgeon clinic, and I can already get that surgery scheduled with them ASAP.
• 17:00
  SPEAKER_00: Any rex over, if it matters so much, where I get the surgery.
• 17:07
  SPEAKER_00: 100%.
• 17:09
  SPEAKER_00: And the thing that I always come back to is what's the cost of another ACL injury?
• 17:14
  SPEAKER_00: And I think that's the big thing to answer here.
• 17:17
  SPEAKER_00: Is seriously look at this and contemplate this, but what's the cost of another ACEL injury to you?
• 17:24
  SPEAKER_00: Sit with that the next time you're making a decision in this process of like, yeah, let me do the most convenient thing, the cheapest thing.
• 17:31
  SPEAKER_00: Now I understand not everyone is afforded the same options, socioeconomic status, and all these different aspects, right?
• 17:38
  SPEAKER_00: But when you are able to, please make the decision that is most important to you because not all surgeons, physical therapists, healthcare is created equal.
• 17:48
  SPEAKER_00: Nowhere in this entire world is it created equal.
• 17:52
  SPEAKER_00: And so, yes, please get your second opinions.
• 17:55
  SPEAKER_00: It is so important, no matter where it is, that your professionals make sure you invest in your health.
• 18:02
  SPEAKER_00: This is an investment, y'all.
• 18:04
  SPEAKER_00: This is not just like, let's do the thing and do the transactional thing, and um, I'm gonna get surgery and then you know, go to the next door and do PT and then I'm good to go in nine months, right?
• 18:14
  SPEAKER_00: It doesn't work that way.
• 18:16
  SPEAKER_00: And I've seen this completely break so many times and break so many people.
• 18:21
  SPEAKER_00: And so this is one of my heartfelt just podcast episodes because I feel this so deeply in my bones because I am one of these statistics, I fell through the cracks, and who knows if I had someone better in this process that I would have not torn my ACL a second time.
• 18:35
  SPEAKER_00: Now, am I thankful for my experiences and my journey?
• 18:39
  SPEAKER_00: Absolutely, because I wouldn't be here talking to you guys and educating you and building a business all around this thing.
• 18:45
  SPEAKER_00: I love it, I'm so obsessed with it.
• 18:47
  SPEAKER_00: But with that said, the goal of this is to make sure you guys don't make these same mistakes.
• 18:52
  SPEAKER_00: So get your second opinions, invest in yourself.
• 18:56
  SPEAKER_00: If your gut's telling you it's not working, this professional is not right, you deserve to follow that.
• 19:03
  SPEAKER_00: And yeah, it might be hard, but there's choosing hard.
• 19:07
  SPEAKER_00: You can either choose that hard now and then have an easier payoff later, or you just kind of let it ride out, and then you're gonna choose a hard later.
• 19:15
  SPEAKER_00: And that might be delayed recovery, it might not be getting back to what you want to do, or worst case scenario is having another injury.
• 19:22
  SPEAKER_00: And while I don't like to be raw with you guys too much about this, it's just the reality of what we see, and it is something that needs transparency in this space.
• 19:32
  SPEAKER_00: And I think it starts with us as healthcare professionals.
• 19:35
  SPEAKER_00: But I know there's not always a ton of surgeons listening to this because who wants to probably listen to Ravi Patel PT talk about this stuff all the time.
• 19:45
  SPEAKER_00: But with that said, you guys are listening to this.
• 19:48
  SPEAKER_00: Whether you are a PT coach, maybe you are a surgeon, or maybe you are an ACLer, you are able to equip yourself with this knowledge to make better decisions.
• 19:59
  SPEAKER_00: So now that you have this, think about vetting your people as best as you can to make sure they are the right people for your team.
• 20:06
  SPEAKER_00: And hey, this could change.
• 20:08
  SPEAKER_00: It could be great for the first three months, and maybe it changes at month four.
• 20:12
  SPEAKER_00: So just know that this can change and you got to do what's best for you because you got to take care of yourself in the ACL rehab process and make sure you are your own advocate because there's gonna be no one else that's gonna be a better advocate for you than you.
• 20:25
  SPEAKER_00: So I hope this helps, team.
• 20:27
  SPEAKER_00: I know that this was probably just a rant and a tangent, but this is something that I felt very strongly about with this episode.
• 20:34
  SPEAKER_00: And I just wanted to share it with all of you to just make sure don't settle, make sure vet your PT, get a second opinion with your surgeon, a different surgeon in this process.
• 20:47
  SPEAKER_00: And that way you can make sure you have all the information you need to make the best informed decision, give you your best shot.
• 20:53
  SPEAKER_00: Until next time, team.
• 20:55
  SPEAKER_00: This is your host, Robbie Patel, signing off.