Latest / The ACL Athlete Podcast / 007 | 8 Questions You Should Ask Your Surgeon Before ACL Surgery - Part 1

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007 | 8 Questions You Should Ask Your Surgeon Before ACL Surgery - Part 1 · The ACL Athlete Podcast

• 0:19
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:23
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:33
  SPEAKER_00: I'm your host, Dr.
• 0:34
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:38
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:46
  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.
• 0:57
  SPEAKER_00: Thanks for joining.
• 0:58
  SPEAKER_00: Now let's dive into today's episode.
• 1:04
  SPEAKER_00: What is up everyone, and welcome back to the ACL Athlete Podcast.
• 1:10
  SPEAKER_00: So today I'm in a podcasting mood, so we are going to start off with a fun fact about myself, because I can.
• 1:18
  SPEAKER_00: And uh this fun fact is that I grew up in a motel my entire life, uh, until I was of the age of 18.
• 1:27
  SPEAKER_00: So my parents moved from India and started their own business in a small town called Folkestone, Georgia.
• 1:33
  SPEAKER_00: And I love that town, and it was awesome, and we were one of the only motels in the city, and uh actually they still own the motel to this day.
• 1:43
  SPEAKER_00: And uh my brother and I shared a room uh for our entire lives until he went to college.
• 1:50
  SPEAKER_00: So that was my life.
• 1:52
  SPEAKER_00: You know, we were a part of the front office, so we had a home connected, and so anytime a you know, someone came to rent a room, we would hear the doorbell ring, and it was just normal nature to kind of get up and go, you know, serve that person and be able to rent them a room or whatever was going on, whether they needed towels.
• 2:14
  SPEAKER_00: And uh the more that I have told people this, the more that they're like, that is super weird and also super cool.
• 2:20
  SPEAKER_00: So that's just a little side note about me.
• 2:23
  SPEAKER_00: But now getting to the real point of why you guys are here.
• 2:27
  SPEAKER_00: So today I wanted to talk about eight questions to ask your surgeon before ACL surgery.
• 2:35
  SPEAKER_00: Now, this is not an exhaustive list, and I just want you guys to know that each question itself could be its own episode.
• 2:44
  SPEAKER_00: But today the focus is on a list, so we'll touch on these different items, and it'll be very specific to your situation.
• 2:51
  SPEAKER_00: So maybe not all of these questions apply.
• 2:54
  SPEAKER_00: So that's where you just kind of have to take these and make sure that they fit uh for you or for the person that you're working with.
• 3:02
  SPEAKER_00: So these are some things to consider, along with just being respectful, right?
• 3:06
  SPEAKER_00: So this is just a good human characteristic to approach with anyone, but especially when you're walking into this situation, it can be very daunting, it can be hard because there's so much information going on, and typically you just don't know as much about the process, especially if it's your first time.
• 3:25
  SPEAKER_00: So just approach this whole situation and the conversation with respect, and that's what you'll get.
• 3:31
  SPEAKER_00: So that's one thing that I just wanted to share before diving into these questions.
• 3:37
  SPEAKER_00: So this will be part one of these series of questions.
• 3:41
  SPEAKER_00: Uh, so let's just dive straight into it.
• 3:44
  SPEAKER_00: So the first one is do I need ACL surgery?
• 3:49
  SPEAKER_00: And if you look at what is commonly done, as soon as you tear your ACL, at some point soon after, you will go and just have an ACL reconstruction, and then you do rehab, and then so on.
• 4:02
  SPEAKER_00: That is the normal process that you will see, especially because this is more common with athletes, and if they're trying to get back to their sport or you see this on TV, it's very common that they'll go into surgery pretty soon after.
• 4:16
  SPEAKER_00: Now, with that said, there has been so much more research that has come out about non-operative approaches to ACL rehab, and I think that there's a lot of value here because there have been some really cool studies that have shown that people will have the same outcomes two and five years out.
• 4:35
  SPEAKER_00: You know, before it was all of these myths about, you know, arthritis is increased risk or you know, damage to the meniscus, and you know, that is a conversation for another day.
• 4:48
  SPEAKER_00: But with that said, there is value to having the non-operative reproach.
• 4:54
  SPEAKER_00: And this will ultimately be based on your goals as an athlete, right?
• 5:00
  SPEAKER_00: So if you are someone who is younger and is trying to get back to cutting and pivoting sports like soccer or basketball, then there is a good chance that you need ACL surgery.
• 5:12
  SPEAKER_00: But maybe you're older and you tore your ACL because you fell off of a chair and you walk and you cycle, but you don't really do any cutting, pivoting, then maybe ACL surgery isn't necessarily what you need, and you can just do a non-operative approach and just see how things go.
• 5:32
  SPEAKER_00: So I think this is a question that should come up more often, but just remember that it's going to be really focused on you as a person and your goals that you're trying to get back to.
• 5:43
  SPEAKER_00: Number two, what are my graft options?
• 5:47
  SPEAKER_00: So, to put this very simply, when you have an ACL reconstruction, uh there are two categories that the ACL graft is harvested from.
• 5:57
  SPEAKER_00: So it's an autograft or an allograft.
• 6:00
  SPEAKER_00: So an autograft is tissue taken from yourself, and an allograft is tissue taken from someone else.
• 6:08
  SPEAKER_00: A cadaver graft is what you'll typically hear.
• 6:12
  SPEAKER_00: Now, these graphs can be broken down into your quadriceps tendon, your patellar tendon, your hamstring tendon.
• 6:20
  SPEAKER_00: So they'll take one of these pieces and then turn it into your new ACL.
• 6:25
  SPEAKER_00: So this is something that you should ask because based on your situation, so for me, I always recommend if you're a younger female athlete that trying to push away from getting a hamstring tendon is very valuable because having that as a knee stabilizer is very important, and if you can take that from something else, I am a bigger fan of that personally.
• 6:52
  SPEAKER_00: Now, with that said, it is going to really depend, and that leads me into my next question, which is what graphs do you do the most, and how many per year?
• 7:06
  SPEAKER_00: Now, this is an important question because you want to find what the surgeon is most comfortable with.
• 7:12
  SPEAKER_00: Some people will go in and they'll be like, I want a bone patella bone.
• 7:16
  SPEAKER_00: Uh, and that is something that the surgeon might not be comfortable with.
• 7:21
  SPEAKER_00: So you either have to decide, do I find a different surgeon who is really good with that, or do I stick with this surgeon and maybe they're really good at doing a quad tendon graft.
• 7:31
  SPEAKER_00: Now that's where it's okay to ask them because sometimes they'll just say, like, oh, you'll get a hamstring tendon and you're done.
• 7:39
  SPEAKER_00: But I think that there is value in asking and also asking them their opinion on the pros and cons based on your goals and who you are, and allow them to explain, well, this is why I think that this is best.
• 7:53
  SPEAKER_00: And then do your own research with it, right?
• 7:55
  SPEAKER_00: But this allows you to know what is in their wheelhouse and what they feel most comfortable with.
• 8:01
  SPEAKER_00: And to the second part of this question, how many per year?
• 8:04
  SPEAKER_00: I think that there is value to that because you know, when you are trying to work with somebody, you know, say someone asks me how many shoulders have you worked with or how many ACLs athletes have you worked with, you know, I want to be able to give them an answer to that and know that I have gotten in the reps to be able to show uh I've worked with these clients and these people who are going through this issue.
• 8:28
  SPEAKER_00: So the same thing can be said with the surgeon of asking, you know, how many reps have they had in terms of how many ACL surgeries of this specific graft have you done each year?
• 8:38
  SPEAKER_00: And I think that if you ask that in a very respectful way, they will happily respond to that.
• 8:43
  SPEAKER_00: So then that leads to number four, which is do I need physical therapy before surgery?
• 8:51
  SPEAKER_00: Now, depending on the injury and insurance and whether you decide to have surgery, all these things are very important to consider.
• 9:00
  SPEAKER_00: But I believe that physical therapy, sometimes called prehab, which is prehabilitation that you hear all the time, uh, to so that's rehab before surgery, is very, very, very, very important.
• 9:15
  SPEAKER_00: So, research really supports having this prehab and this ability to restore your knee function back to where it normally is.
• 9:25
  SPEAKER_00: So that means getting your range of motion back, um, letting the swelling calm down, making sure that the quads are still staying really, really strong because what you'll notice is that some weakness will sit in, or maybe some atrophy to the quads.
• 9:40
  SPEAKER_00: So these are all really good things to be able to work on as you're progressing into the surgery.
• 9:46
  SPEAKER_00: And this can be, you know, anywhere from four to six, eight weeks, if not longer, depending on you know what you have lined up.
• 9:55
  SPEAKER_00: I think that especially if it is not time sensitive, this should be a requirement for any ACL injury.
• 10:03
  SPEAKER_00: And my reason for this is because it helps so much to be able to get you acclimated to the process.
• 10:09
  SPEAKER_00: Um, so that way you get to meet the physical therapist or whoever you are working with before the surgery.
• 10:17
  SPEAKER_00: It allows you to prepare and know what's expected.
• 10:20
  SPEAKER_00: You get used to the process of doing exercises and being on the lookout for certain things.
• 10:27
  SPEAKER_00: And it helps you be in a better place mentally as well.
• 10:30
  SPEAKER_00: So for my own two ACL surgeries, I did not do any.
• 10:36
  SPEAKER_00: I take that back.
• 10:37
  SPEAKER_00: For my first one, I did not do any physical therapy before it.
• 10:41
  SPEAKER_00: But for my second one, I did do physical therapy before it.
• 10:44
  SPEAKER_00: And it made a huge difference in my outcomes, along with having already one ACL surgery under my belt.
• 10:52
  SPEAKER_00: But I just could tell that I it was almost this on-ramp of as I started my prehab and then I had my surgery, it was just a continuation of the process instead of this you know waiting period, allowing things to get weak and just waiting for the surgery and then hitting the on-ramp.
• 11:13
  SPEAKER_00: I think that it just sets you up for the best outcomes possible, and the research really does support that.
• 11:19
  SPEAKER_00: So, with that said, you know, if you're having to deal with insurance and figuring out deductibles and the amount of visits, this is where being strategic about, you know, maybe it's one session, two sessions.
• 11:33
  SPEAKER_00: Um, if you want to save a bulk of the sessions for the post op and the return to sport process, um, just know how many physical therapy visits that you have and strategize that for you know the prehab and the nine months after your surgery.
• 11:50
  SPEAKER_00: So that's it for part one.
• 11:53
  SPEAKER_00: I just wanted to focus on these questions because I think that there is a lot to unpack.
• 11:58
  SPEAKER_00: And again, you know, as I mentioned in the beginning, I think it's really important that you know you approach this with respect, you make sure that you take it with the situation that you are in specifically, and just making sure that you know the other questions that you have that you have them answered.
• 12:19
  SPEAKER_00: So, you know, other things may come up, but these are the things just to keep in mind as you're getting ready for ACL surgery.
• 12:27
  SPEAKER_00: So that's it for part one today.
• 12:30
  SPEAKER_00: And if you guys have any feedback or any questions related to this, please send me a message and be happy to answer them.
• 12:38
  SPEAKER_00: But that's it for today.
• 12:39
  SPEAKER_00: So, thank you all so much for listening to the ACL Athlete Podcast.