Latest / The ACL Athlete Podcast / 278 | How to Navigate a Second ACL Opinion: Before Surgery, After Surgery, and Complex Cases

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278 | How to Navigate a Second ACL Opinion: Before Surgery, After Surgery, and Complex Cases · 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 ACL, 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: Robbie 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 welcome back to another episode on the ACL Athlete podcast.
• 1:06
  SPEAKER_00: Today is about something that comes up constantly once someone is dealing with an ACL injury or this recovery process in general.
• 1:16
  SPEAKER_00: And it's something that I am finding that we are navigating and helping a lot of athletes navigate is getting another opinion.
• 1:27
  SPEAKER_00: And that could be from the surgeon side or an orthopedic side.
• 1:32
  SPEAKER_00: That could be from the physical therapy side, it could be from the coaching side.
• 1:36
  SPEAKER_00: But there are a lot of situations that we are navigating where people are coming in, they have had one provider or a set of providers, or maybe multiple.
• 1:45
  SPEAKER_00: Like we've had people who have come in and they've had tons of different surgeons or orthos.
• 1:50
  SPEAKER_00: They've had tons of different PTs, and this could be over the course of weeks and months, it could also be over the course of years.
• 1:57
  SPEAKER_00: And so we find that we're having to help people navigate very complex circumstances sometimes, whether that's something that they are not feeling they are being heard on, or maybe it's not being addressed, or they just don't necessarily have the expertise or specialty to help the case, right?
• 2:15
  SPEAKER_00: You're not feeling like you're getting what you need, especially for you know this one body that we have, this one knee, or maybe both knees.
• 2:23
  SPEAKER_00: You'd be surprised how many double ACLs there are, but it happens.
• 2:27
  SPEAKER_00: And so this is something that I think is really important for us to be able to understand how to navigate.
• 2:34
  SPEAKER_00: And this might mean you're deciding whether to have your first ACL surgery, a second ACL surgery, a third.
• 2:41
  SPEAKER_00: It could be comparing multiple surgical opinions, or you've already had the ACL reconstruction and the surgery, and something is just not adding up, right?
• 2:51
  SPEAKER_00: And you are potentially already with a particular surgeon, and you are not getting what you need out of it.
• 2:59
  SPEAKER_00: And so then you're trying to decide do I go see someone else?
• 3:02
  SPEAKER_00: Do I ride this out?
• 3:04
  SPEAKER_00: What should I do?
• 3:05
  SPEAKER_00: And just know that this can apply across pretty much any provider for the most part.
• 3:11
  SPEAKER_00: Like you're dealing with a shoulder, you're dealing with any type of medical diagnosis.
• 3:15
  SPEAKER_00: The principles of this episode apply across all of medicine for the most part.
• 3:20
  SPEAKER_00: And it's really important for us to just know how to properly navigate this.
• 3:26
  SPEAKER_00: And also knowing that this is something that I want to provide practical takeaways from and guidance versus it just being this theoretical, go get your opinions, get the second opinion, get the third opinion, which I know I've shared with you guys about, but I want to make this super practical today.
• 3:43
  SPEAKER_00: The thing is, like your progress may have stalled, um, symptoms aren't necessarily improving.
• 3:49
  SPEAKER_00: Maybe you do feel dismissed or rushed through appointments.
• 3:52
  SPEAKER_00: I can't tell you guys how much we as a team talk about this of just athletes who are just not being hurt in their ortho visits, and it drives me crazy.
• 4:01
  SPEAKER_00: Or they're seeing in-person PTs somewhere else, and the PTs are just moving along and they're just feeling like this conveyor belt in this process.
• 4:10
  SPEAKER_00: But the thing is that you're also potentially wanting another set of eyes in your situation, right?
• 4:16
  SPEAKER_00: You want to make sure you do it right, you don't want to waste time, and that's the biggest thing is time can just really compound, and then before you know it, you're like, all right, I'll get to it in a week or you know, a few weeks, and then all of a sudden it's three months later, and you're like, wow, what happened?
• 4:30
  SPEAKER_00: Right, and you're still in the same place.
• 4:33
  SPEAKER_00: And so this episode is gonna build off of 266 where I did talk about complex cases, where you know, the more complex it is, the more opinions you need, right?
• 4:42
  SPEAKER_00: I dove into that a little bit deeper, but today is the practical version of this.
• 4:48
  SPEAKER_00: And so I want to make sure we can walk through this.
• 4:52
  SPEAKER_00: If you are someone in this process and you might be someone who is approaching your first ACL reconstruction and somehow you have stumbled on this episode, that's awesome, and you're navigating more than just one opinion, right?
• 5:06
  SPEAKER_00: You have been recommended this particular surgeon by somebody, or you Googled somebody, they had great ratings, and you went to go see the first house that you're potentially gonna buy, right?
• 5:16
  SPEAKER_00: And you decide to buy it, right?
• 5:18
  SPEAKER_00: And that's okay.
• 5:19
  SPEAKER_00: Maybe it is the dream situation, all of it checks all the boxes, you ask them all the questions, it blew you away.
• 5:26
  SPEAKER_00: That's awesome.
• 5:27
  SPEAKER_00: I will say in medicine, it's pretty easy to kind of do that in a sense because it's just complicated.
• 5:34
  SPEAKER_00: So then, therefore, you want someone who's smart to be able to tell you what to do.
• 5:37
  SPEAKER_00: And most orthos walking into a room are going to tell you what to do.
• 5:42
  SPEAKER_00: There's not very much of a timid orthopedic surgeon that exists.
• 5:46
  SPEAKER_00: And so this is something that I think is really important in terms of knowing whether it's your first ACL reconstruction, a second, or again, like the multiple opinions.
• 5:57
  SPEAKER_00: So I want this to kind of cover a broad spectrum because it can apply across a lot of different cases, whether it's your initial ACL or just a complex case where you're trying to find other opinions.
• 6:09
  SPEAKER_00: And different surgeons and providers can recommend completely different things: different graph choices, different surgical approaches, rehab expectations, return to support timelines, testing, or honestly a lack thereof, different explanations for the same symptoms, even just kind of nuances of techniques, positioning, all this stuff is very different across a lot of providers.
• 6:36
  SPEAKER_00: Even in rehab, you will see a bunch of PTs having different philosophies around the way that rehab can go.
• 6:43
  SPEAKER_00: Now, I will say there is a base of principles, science, criteria, research that shows how this should kind of progress, but there are going to be so many different philosophies that exist.
• 6:55
  SPEAKER_00: And you kind of think about schooling, you think about training, exposure, all these things are gonna influence things, and especially on the surgical side, nuke techniques are always evolving.
• 7:05
  SPEAKER_00: Some people choose to, you know, get with the times, and some people just stay in their ways, right?
• 7:10
  SPEAKER_00: You think about the 20 years out surgeon from doing 20 years of ACL work, right?
• 7:15
  SPEAKER_00: Knee work, or the two-year out surgeon, or maybe it's the 30 years out surgeon, right?
• 7:20
  SPEAKER_00: It can span the entire spectrum, and those surgeons could be keeping up with things, the highest and best technique, or it could also be just what they learned at the first day of their residency and fellowship, and they're still doing that same stuff 20, 30 years later, right?
• 7:36
  SPEAKER_00: So it could be just repeated years.
• 7:38
  SPEAKER_00: So I think this is really important because I kid you guys not.
• 7:42
  SPEAKER_00: We are navigating so many different cases right now.
• 7:44
  SPEAKER_00: We talk with as a team where people are needing second opinions, third opinions, complex ACL cases.
• 7:51
  SPEAKER_00: I wish that we could just get the straightforward ACL cases, and we do have those, and those are amazing, and those tend to go a bit smoother.
• 7:58
  SPEAKER_00: But we also have a lot of people who don't find us till later, and we have to help them navigate situations that are beyond just purely let's rehab this thing and it'll get better.
• 8:09
  SPEAKER_00: And a lot of times it does.
• 8:10
  SPEAKER_00: And there are definitely instances where it is truly a biological thing that we need to evaluate further.
• 8:17
  SPEAKER_00: And this is where having a good surgeon or another opinion can be so valuable.
• 8:21
  SPEAKER_00: But the thing is, there can be a lot of differences in opinion, and that is so important.
• 8:27
  SPEAKER_00: Just remember that a consultation or evaluation you do with someone, it's not a commitment.
• 8:32
  SPEAKER_00: It doesn't mean you're locked in.
• 8:33
  SPEAKER_00: Who cares if your insurance or whatever you submitted it to has put that doctor on the list to do an evaluation for you?
• 8:42
  SPEAKER_00: There's no commitment.
• 8:44
  SPEAKER_00: You could do four different follow-up sessions before you have the surgery.
• 8:48
  SPEAKER_00: You're still not committed.
• 8:49
  SPEAKER_00: Even after the surgery, if you hated the surgeon and you never want to speak to them again, you can change your surgeon.
• 8:55
  SPEAKER_00: You could do the same thing for any provider, physical therapist, whoever it may be.
• 8:59
  SPEAKER_00: And so just know you are the person in control.
• 9:02
  SPEAKER_00: You need to be in the driver's seat, and you are needing to make the best decision for your case, your knee, and this is your life, y'all.
• 9:09
  SPEAKER_00: You are collecting information in this first phase.
• 9:13
  SPEAKER_00: That is exactly what step one is gathering information.
• 9:16
  SPEAKER_00: You're not making decisions.
• 9:18
  SPEAKER_00: So make that step one.
• 9:20
  SPEAKER_00: The principle is just gonna be so simple as to just get more than one opinion.
• 9:25
  SPEAKER_00: And I think that this is really important, even with the go-to surgeon or whoever it may be.
• 9:31
  SPEAKER_00: I think that there's always value when you're doing surgery to get at least more than one opinion, get two at least.
• 9:37
  SPEAKER_00: And the more complicated it is, the more you're gonna want to get.
• 9:40
  SPEAKER_00: Now, as I shared, there's gonna be differing opinions based on these surgeons, graph choices, surgical techniques, everything that can kind of come into this, right?
• 9:49
  SPEAKER_00: They'll look at different MRIs and they'll say, you know, they see this versus another surgeon says they see this, this is what they would do, versus another one would do something different.
• 9:58
  SPEAKER_00: Y'all, I've heard the spectrum, I hear it every single week.
• 10:01
  SPEAKER_00: There's so much variation in this.
• 10:03
  SPEAKER_00: But just know you're collecting that info, you're not locking yourself into that decision.
• 10:08
  SPEAKER_00: If you're pre-surgery, start with a simple list of surgeon names from trusted resources.
• 10:12
  SPEAKER_00: Like, you know, maybe you know a physical therapist or a friend or coaches, athletes who have raving reviews about these people.
• 10:20
  SPEAKER_00: I would have a just kind of caveat or asterisk around the pro team surgeons.
• 10:27
  SPEAKER_00: While yes, there can be good ones that I know that are awesome.
• 10:31
  SPEAKER_00: There are also ones that I think details fall through their cracks and they kind of funnel you through, especially if you're not a pro athlete.
• 10:38
  SPEAKER_00: And so this is just kind of the game that's played within healthcare and within just the way that things can go.
• 10:45
  SPEAKER_00: And so I think it's important to craft a list.
• 10:48
  SPEAKER_00: And just like you are buying a new house, you are going to craft a list of maybe some potential homes that fit certain criteria, right?
• 10:55
  SPEAKER_00: You're not just gonna be like, okay, my realtor sent me this awesome house.
• 10:59
  SPEAKER_00: Like, I see it, it's in my budget.
• 11:01
  SPEAKER_00: Looks great.
• 11:02
  SPEAKER_00: You're gonna probably list a few things that are important to you.
• 11:04
  SPEAKER_00: Do you care about there being, you know, two or three bathrooms?
• 11:08
  SPEAKER_00: Do you care about there being an island in the house?
• 11:10
  SPEAKER_00: Do you care about there being a yard?
• 11:12
  SPEAKER_00: Do you care about the color of it?
• 11:14
  SPEAKER_00: What does the interior look like?
• 11:15
  SPEAKER_00: Are you gonna have to gut it?
• 11:16
  SPEAKER_00: Are you gonna have to like just move in and you know, just add furniture?
• 11:20
  SPEAKER_00: There are gonna be so many criteria you're gonna be looking at for a house that you're gonna buy.
• 11:25
  SPEAKER_00: It's gonna be the same thing for a surgeon or for a physical therapist or anyone who's gonna be on your team.
• 11:30
  SPEAKER_00: And so this is something that we want to make sure that we kind of craft a list of this information of like what are particular things that are important to us.
• 11:38
  SPEAKER_00: But if your your post-surgery feels off, if you know things are not adding up in your gut, you need to define what that concern is.
• 11:50
  SPEAKER_00: Whether it's the persistent pain you're dealing with, swelling that keeps returning, maybe it's that loss of range of motion, the extension that's just not getting there, no matter how how hard you try, your flexion is not budging, you know, you're getting clicking or catching that just doesn't add up more than the normal what we would expect.
• 12:08
  SPEAKER_00: Maybe your knee's kind of giving way a little bit.
• 12:10
  SPEAKER_00: It's not fully giving out, but like it's just kind of like giving out a little bit, coming back into place.
• 12:15
  SPEAKER_00: You're constantly having these setbacks or flare-ups.
• 12:18
  SPEAKER_00: Maybe your strength is not progressing at all, no matter how hard you work, or you just kind of feel like you're not being heard.
• 12:24
  SPEAKER_00: You're kind of just being told, uh, just keep working at it, just keep going, right?
• 12:29
  SPEAKER_00: All of that is valid input for a second opinion.
• 12:32
  SPEAKER_00: So I want you to define that, especially if you're struggling with something and not being heard.
• 12:38
  SPEAKER_00: I want you to define that and start gathering that information, right?
• 12:43
  SPEAKER_00: Step two, understand logistics before you get too attached to any process here.
• 12:50
  SPEAKER_00: Before scheduling anything, understand how access and costs work.
• 12:54
  SPEAKER_00: And I think this is very pertinent.
• 12:57
  SPEAKER_00: If you're in a system with insurance, look at in-network versus out of network coverage, deductibles, coinsurance, out-of-pox maximums, see if there's overlap between in-network and out of network coverage.
• 13:10
  SPEAKER_00: It loaths me to kind of talk about this because I just despise insurance so much and these pro, you know, profit companies who care about their bottom line.
• 13:21
  SPEAKER_00: But the thing is that you need to know how these operate, especially if you're in the US.
• 13:26
  SPEAKER_00: If you're in a different healthcare system or country, the principles can still apply.
• 13:31
  SPEAKER_00: Understand how the care is accessed and paid for before committing because surgery and the procedures are rarely just one single bill, right?
• 13:39
  SPEAKER_00: It can be assumed that way of like, okay, I got surgery and it's all gonna get covered by my insurance.
• 13:44
  SPEAKER_00: But you need to understand what these numbers are, especially in this day and age of 2026, these deductibles, these out-of-network coverages, certain things are covered versus not.
• 13:54
  SPEAKER_00: So you need to understand because especially if you go to a city and you're looking at different surgeons, there are many people I'm currently working with in our team where there are some who have in-network surgeons, and then there are some who are out of network.
• 14:09
  SPEAKER_00: And sometimes those out of network surgeons are some of the best ones.
• 14:13
  SPEAKER_00: And so then, therefore, we have to decide is it worth it to go out of network?
• 14:17
  SPEAKER_00: Then you have to decide is there gonna be overlap between the in-network versus out of network?
• 14:22
  SPEAKER_00: So these are just details we need to understand in logistics, and as much as it pains me to ask people to have to figure this stuff out, it's important because you need to understand logistically how this is gonna be influenced.
• 14:37
  SPEAKER_00: Because if there's this surgeon that you really love, but everything out the door is gonna cost$50,000 for you to get this surgery.
• 14:46
  SPEAKER_00: Let's think about that.
• 14:48
  SPEAKER_00: There's a lot of things in your life that could go a long way for$50,000.
• 14:52
  SPEAKER_00: And I'm not saying it's not worth it, but at the same time, I think that there's probably another alternative we can pursue before you have to spend that much cash, even if you even have the ability to do that, right?
• 15:03
  SPEAKER_00: And most people don't even necessarily have the means to do that.
• 15:06
  SPEAKER_00: I know I didn't, whenever I had my ACL procedures, and it's just something that we need to make sure we consider because we don't want to jump into things too quickly and then all of a sudden get a bill later.
• 15:17
  SPEAKER_00: So because the surgery and procedures are rarely one bill, you may see surgeons' fees, which can be separate, facility or hospital charges that are separate, anesthesia fees, imaging costs, follow-up visits, additional procedure-related costs.
• 15:36
  SPEAKER_00: And I have so much exposure to this, especially with my hip surgery recently.
• 15:40
  SPEAKER_00: I mean, there's separate doctor fees, there's separate surgery fees, and those are probably the two biggest ones, and then anesthesia is probably going to be another one.
• 15:49
  SPEAKER_00: Those are the three main categories you typically see that are the main umbrellas of cost that can be divided into.
• 15:57
  SPEAKER_00: But the thing is, you need to understand okay, is your anesthesiologist in network?
• 16:02
  SPEAKER_00: Is the you know surgeon in network?
• 16:05
  SPEAKER_00: And then is the hospital in network?
• 16:08
  SPEAKER_00: Because there have been situations with athletes where their surgeons in network, but their hospital and their anesthesiologists are not, which is just wild.
• 16:17
  SPEAKER_00: And they don't find out until later.
• 16:19
  SPEAKER_00: And so this is something that they get hit with this bill because the insurance doesn't cover it, and this is something that I'm not trying to put fear in you guys.
• 16:26
  SPEAKER_00: My goal is to be transparent, and the main point of this particular part is to just understand the logistics, use AI to help understand.
• 16:37
  SPEAKER_00: Okay, this is what my insurance card says.
• 16:39
  SPEAKER_00: I call them, this is what they tell me, help me break this down in plain, simple terms to be able to understand what is it that I'm looking at, and then just be able to distill it all down so you are very well informed about what you're gonna spend and also what does this look like if you're getting multiple opinions.
• 16:58
  SPEAKER_00: What exactly is included in these estimates?
• 17:02
  SPEAKER_00: That one question matters a lot.
• 17:04
  SPEAKER_00: So we've gone through step one, which is gathering the info, not making any decisions yet.
• 17:09
  SPEAKER_00: Step two, understanding the logistics before you get too attached to any type of provider or facility.
• 17:16
  SPEAKER_00: And then step three is organize your case and your story.
• 17:19
  SPEAKER_00: This becomes especially important when seeking another opinion after surgery.
• 17:25
  SPEAKER_00: Build a very clear timeline.
• 17:27
  SPEAKER_00: Injury date, surgery date if you've had one, the graph type, the procedure, symptoms over time, imaging results, rehab history, your physical therapy, how has that progressed, what improved symptoms, what worsened symptoms.
• 17:44
  SPEAKER_00: Now an important nuance.
• 18:01
  SPEAKER_00: They actually left out a procedure that was important to the case as well.
• 18:05
  SPEAKER_00: So they didn't transfer over the full story.
• 18:07
  SPEAKER_00: They also kind of lied about what she was presenting with and how her knee looked versus what it actually is looking like.
• 18:15
  SPEAKER_00: And so that is just kind of a side tangent.
• 18:18
  SPEAKER_00: But I think a lot of times places like this overlook maybe the details and they use these templated, like, okay, check their full range of motion, MMT strength is great, X, Y, and Z, as if it's this template they apply across most typical follow-ups.
• 18:34
  SPEAKER_00: And so this is something that you have to check because it is really important for your story, especially if you're getting that information sent to another provider.
• 20:49
  SPEAKER_00: That happens more often than people think.
• 20:51
  SPEAKER_00: So don't assume your medical records tell the full story.
• 20:54
  SPEAKER_00: They're a snapshot of it, but it's also not your lived experience.
• 20:57
  SPEAKER_00: So when you're transferring the records, ask yourself does this actually match what I experienced and what I had shared about your timeline?
• 21:06
  SPEAKER_00: Not to necessarily challenge anyone, not to correct your surgeon even, but to make sure that the next provider is working with the complete picture because that incomplete input is going to lead to incomplete conclusions.
• 21:22
  SPEAKER_00: That's really important.
• 21:23
  SPEAKER_00: Now you can potentially override that with walking into the session or the evaluation and talking through that and saying, well, that doesn't align, but you'd rather have all that information aligned correctly so then that way the surgeon has a full picture and they can come into your session fully prepared with the game plan while also talking to you.
• 21:42
  SPEAKER_00: The other part to this, too, is that you want to make sure, let's say you have a stickler of an insurance provider and they need all the documentation.
• 21:51
  SPEAKER_00: And let's say the previous provider had said, Oh, well, the knee's normal, and then you go to get another opinion and they deny covering that visit.
• 21:59
  SPEAKER_00: Well, we need to show proof that the previous visit makes sense.
• 22:04
  SPEAKER_00: Like it needs to tell a story to further require medical attention and medical help.
• 22:10
  SPEAKER_00: And so that's where knowing that the documentation is there and you have also expressed that this is incorrect if it is, I think that's really valuable and really important.
• 22:20
  SPEAKER_00: So make sure to organize your case and your story, make sure it's reflective on your medical documentation, and you need to make sure that you gather that medical information.
• 22:30
  SPEAKER_00: A lot of times with imaging, for example, you will have to either send it through a HIPAA compliant kind of channel that they will direct you on.
• 22:40
  SPEAKER_00: And there's also the old school things where they will burn this thing on a CD, which is something I had to do as of 2025.
• 22:49
  SPEAKER_00: Still happening, y'all.
• 22:50
  SPEAKER_00: I had to get a paid envelope and I had to mail it to the surgeons to get a second opinion.
• 22:58
  SPEAKER_00: So that is something that is just really important to just consider with this, is that you might have to physically get copies of these things and mail them to the surgeons if you're doing a remote console, for example, or if you are going to go in person somewhere and fly there or drive there, then they will need that information in order to see the full picture, especially for imaging.
• 23:20
  SPEAKER_00: So make sure that you have all that information gathered.
• 23:24
  SPEAKER_00: Then in step four, you're going to interview the provider.
• 23:27
  SPEAKER_00: A lot of people walk in thinking they are going to be assessed themselves, but you're also assessing them, right?
• 23:34
  SPEAKER_00: It's the same thing as like an interview.
• 23:36
  SPEAKER_00: They're interviewing you, but you're going to interview them too.
• 23:39
  SPEAKER_00: It's an evaluation on both sides of this table, not just one side.
• 23:44
  SPEAKER_00: So if you're pre-surgery, ask why this graph for me?
• 23:47
  SPEAKER_00: What are the trade-offs?
• 23:48
  SPEAKER_00: What does return to sport realistically look like?
• 23:51
  SPEAKER_00: What is their philosophy on that?
• 23:52
  SPEAKER_00: What are the criteria that they typically look at for returning to sport?
• 23:58
  SPEAKER_00: And then what are also potentially the biggest risks in my case, right?
• 24:02
  SPEAKER_00: So these are all the things that.
• 24:04
  SPEAKER_00: You can ask them along with many other questions, which I've done podcast episodes on, but this is something that you need to get a little bit more detail on what it is that they're going to be doing, the graphs, also, what is their philosophy around just the overall rehab process.
• 24:19
  SPEAKER_00: If you're post-surgery or dealing with a complex situation, you have to ask, does this fit my normal recovery?
• 24:25
  SPEAKER_00: Would you order more imaging?
• 24:27
  SPEAKER_00: Could something be missing here?
• 24:29
  SPEAKER_00: Would you approach this differently?
• 24:31
  SPEAKER_00: What would you focus on with this particular case?
• 24:34
  SPEAKER_00: You're trying to understand how they think, not just what they are recommending.
• 24:38
  SPEAKER_00: And what we find often is that a lot of athletes that we are working with, we find out that they're just not taken seriously enough, or their surgeons just like to say that it'll get better with time, or they don't see any issues.
• 24:56
  SPEAKER_00: And this happens more than we would love to say so much.
• 25:01
  SPEAKER_00: And so what ends up happening is that we have to encourage our athletes to go get another opinion because, based on our experience, because we work with so many complicated cases and so many ACLs in general, that we start to pick up on things pretty quickly.
• 25:16
  SPEAKER_00: And we can start to hear certain things that our athletes tell us that we're just like, okay, this is fitting this particular pattern.
• 25:23
  SPEAKER_00: And a lot of times they're just told, oh, we'll just keep working on strength, keep working on mobility, and it'll get better.
• 25:29
  SPEAKER_00: Oh, it'll get better as it gets goes on, right?
• 25:32
  SPEAKER_00: And it just doesn't add up.
• 25:34
  SPEAKER_00: And I know so many of you probably listening to this have experienced this or are maybe contemplating this.
• 25:41
  SPEAKER_00: And in your gut, it doesn't seem right.
• 25:44
  SPEAKER_00: And the one thing that we always say is like we need to make sure that you have exhausted your rehab as much as you can.
• 25:51
  SPEAKER_00: You can't say, oh, well, my extension is not better, and I have a cyclops lesion if you haven't done any extension work or if you've only done it one or two days a week.
• 25:59
  SPEAKER_00: Like that's not gonna fly either because we need to control the controllables first.
• 26:03
  SPEAKER_00: You need to do your due diligence and do your rehab and be consistent.
• 26:07
  SPEAKER_00: And then we could start to paint a picture, and that's where your rehab history will be so important.
• 26:12
  SPEAKER_00: But if it's not adding up, then that is where we need to start thinking through what are the next steps.
• 26:19
  SPEAKER_00: Like, is it something that we need to get another opinion from someone else, especially if the current surgeon is not listening?
• 26:25
  SPEAKER_00: And obviously, I am talking about more complex cases post-surgery already, versus the initial surgery where you might just be navigating those different opinions.
• 26:36
  SPEAKER_00: So therefore, you might not have these kind of gut feelings of, okay, well, I need to get a second opinion or a third opinion.
• 26:43
  SPEAKER_00: But this is where it just kind of crosses over whether you are on your first ACL surgery or considering surgery versus you're navigating a complex decision, right?
• 26:54
  SPEAKER_00: So those are things that are very valuable to this particular journey.
• 26:59
  SPEAKER_00: And so the last thing that I want to share, step five, compare patterns and not just these opinions of who you're getting opinions from.
• 27:09
  SPEAKER_00: So don't get stuck chasing too much certainty here.
• 27:13
  SPEAKER_00: The biggest thing is that you need to look for patterns.
• 27:16
  SPEAKER_00: As I shared, orthos just in general, like in this space, they're gonna come off confident.
• 27:21
  SPEAKER_00: Like this is what you need to go to.
• 27:23
  SPEAKER_00: We had an athlete who worked with us recently, and they said that they went into a surgeon, and the surgeon said, You have to get this graft.
• 27:33
  SPEAKER_00: You have to.
• 27:34
  SPEAKER_00: And they didn't really provide a reason clearly enough as to why, because we kept asking, like, why are they so confident in this quad graft?
• 27:42
  SPEAKER_00: And like, well, it's the only graph you can do.
• 27:45
  SPEAKER_00: And then we start to kind of dig into this and we start to realize that the surgeon, that's all they do is quad graphs.
• 27:49
  SPEAKER_00: So we're like, of course they're gonna say that.
• 27:51
  SPEAKER_00: But still, it's like there are many different ways that people can go about getting graphs.
• 27:57
  SPEAKER_00: So there's not really any particular you have to do this one unless it's very context specific.
• 28:02
  SPEAKER_00: But for this particular athlete, it didn't necessarily make sense.
• 28:06
  SPEAKER_00: But the surgeon was pressing her into it.
• 28:09
  SPEAKER_00: So it's something that you have to just be aware and cautious of and expect that it they're gonna come in confident.
• 28:16
  SPEAKER_00: So then you need to look for the patterns across these different opinions.
• 28:21
  SPEAKER_00: If multiple providers align, the confidence in that direction goes up.
• 28:26
  SPEAKER_00: That is my general rule of thumb.
• 28:27
  SPEAKER_00: If you start to get providers who are like aligning and like, yes, we all believe that you need to have this particular procedure or this graft, then I would almost be more certain that that would make the most sense, right?
• 28:40
  SPEAKER_00: But then if one opinion is very different, you need to understand why.
• 28:45
  SPEAKER_00: Then you need to make your decision based on their clinical experience, the trust and communication, which I cannot tell you how important that is, y'all.
• 28:54
  SPEAKER_00: Just making sure that they are a surgeon who will not rush you, who will listen, who has good bedside manner, promise they exist, clarity of a plan.
• 29:04
  SPEAKER_00: Um, you feel like they're on your team.
• 29:06
  SPEAKER_00: They are not just like happy to get you into the OR, but they feel like they can get you back to what you want to do, but they have also kind of shared that plan.
• 29:15
  SPEAKER_00: They have been able to guide you on, like, okay, this is what this is gonna look like, this is their philosophy.
• 29:22
  SPEAKER_00: And especially if they're so dialed in with just criteria and testing and not based on timelines.
• 29:28
  SPEAKER_00: You know, you'll also get clarity around like the cost and logistics of the process, but most importantly, confidence in the direction.
• 29:35
  SPEAKER_00: Saying, I've got this, I can help you.
• 29:38
  SPEAKER_00: I've seen this a lot.
• 29:39
  SPEAKER_00: This is exactly what I'm thinking is going on.
• 29:42
  SPEAKER_00: This is the game plan, and this is what the rehab is gonna look like.
• 29:45
  SPEAKER_00: Here's how we're gonna test this, and we will go from there.
• 29:48
  SPEAKER_00: The best provider is not always the most famous one.
• 29:51
  SPEAKER_00: Just remember that.
• 29:53
  SPEAKER_00: The pro team surgeon, I've seen this fail so many different times of people falling through the gaps, assuming that they're the best when honestly there's question marks sometimes.
• 30:03
  SPEAKER_00: And it is the one that fits your knee.
• 30:06
  SPEAKER_00: That's the main goal, your goals and your situation.
• 30:08
  SPEAKER_00: And it could be the two-year-old surgeon, right?
• 30:11
  SPEAKER_00: But they're the ones who listen, they're the ones who are most up to date, they have the experience that within their time that they have been working, and you can lean into that, especially if your gut is telling you that and the multiple opinions and it's kind of converging to that one thing.
• 30:25
  SPEAKER_00: I think there's a lot of value there.
• 30:27
  SPEAKER_00: So once you've made the decision, commit to that next step.
• 30:31
  SPEAKER_00: That might be surgery, it might be imaging, it might be continuing rehab, it might be changing providers, but the goal is clarity.
• 30:38
  SPEAKER_00: It's not just continuing endless opinions because you can keep getting opinions, opinions, opinions, and you can start confusing yourself more.
• 30:46
  SPEAKER_00: Getting another opinion is not about doubting everything, it is about making sure the information you're using is complete enough to make a good, informed decision.
• 30:57
  SPEAKER_00: You only get one body, and sometimes a second set of eyes is what helps everything line up.
• 31:03
  SPEAKER_00: Maybe it's a third set of eyes or a fourth set of eyes.
• 31:06
  SPEAKER_00: But that could be so helpful in this process, especially when it's new, there's a lot of complexity involved, it's permanent, and it is your body and it is your livelihood.
• 31:17
  SPEAKER_00: So, what I want to do is share a quick summary of this because I know I touched on a bunch of things, and as I normally do, I go off on tangents, and I might have kind of weaved you guys through this.
• 31:27
  SPEAKER_00: So I want to kind of bring this back to distill it down.
• 31:30
  SPEAKER_00: So get multiple opinions when decisions feel unclear or complex.
• 31:35
  SPEAKER_00: A consultation is gathering information, just know that.
• 31:39
  SPEAKER_00: It's not committing to anything, it's data collection.
• 31:42
  SPEAKER_00: Organize your timeline so providers understand your full case and what's going on.
• 31:48
  SPEAKER_00: Double check that your medical records match your lived experience of where you are.
• 31:54
  SPEAKER_00: Ask direct questions about the approach, the imaging, and the reasoning.
• 31:59
  SPEAKER_00: Compare patterns across opinions, not isolated recommendations.
• 32:04
  SPEAKER_00: Choose the provider that best fits your situation, not just what their reputation is, and then also just making sure that you check to see logistically, does this make sense from an insurance standpoint or whatever coverage you have, and knowing what that is going to look like for you when you are investing in this procedure and this process.
• 32:27
  SPEAKER_00: If you're in the middle of this decision process right now, just slow it down, make it structured, create a list for yourself based on this, gather the information, get the clarity that you need from all of it, and make sure not to create more and more noise for yourself.
• 32:46
  SPEAKER_00: I think that's so valuable in this and is something that is so needed.
• 32:50
  SPEAKER_00: So if you have any questions in terms of your case or if this podcast episode was helpful and you would like some more clarity around next steps, then please reach out to us.
• 33:01
  SPEAKER_00: We're here to help.
• 33:03
  SPEAKER_00: We have so many fun, complex cases that we get to navigate.
• 33:08
  SPEAKER_00: And while a lot of people might scratch their head, we love these cases and we love working with any ACL athletes.
• 33:15
  SPEAKER_00: We love the simple ones, but we also love the complex ones and we welcome them because it is something that we want to see the people who are not getting better because we know that we have been able to dial in a process.
• 33:29
  SPEAKER_00: We've been able to listen to people more importantly.
• 33:31
  SPEAKER_00: And if we need to get them to someone else to help us move the needle forward, we will.
• 33:36
  SPEAKER_00: We are not hesitant, we are not here to say we have all the answers, but we promise we will guide you and we promise that we will make sure that you feel clarity and confidence through this entire process.
• 33:47
  SPEAKER_00: That is the thing that is so important to us and the core to the ACL athlete.
• 33:51
  SPEAKER_00: So if you need help, please reach out to us.
• 33:53
  SPEAKER_00: Our information is in the show notes, no matter where you live in the world, we are here to help.
• 33:59
  SPEAKER_00: If you are also someone who is just kind of struggling and just needs some input, please just reach out to us.
• 34:07
  SPEAKER_00: We are wanting to be a soundboard for any ACL athletes, clinicians, coaches who are listening.
• 34:12
  SPEAKER_00: But I'm gonna go ahead and wrap this up because it's been long enough.
• 34:15
  SPEAKER_00: This is your host, Robbie Patel, signing off.