Torn ACL

[supercell]

I dunno @dk_b. Is matching the graft type you want more important than the surgeon's experience and skill level?

I think ideally you want medical advice on which graft type is best for your child, but at the same time, you also want a surgeon who specializes in that graft type, has done it hundreds of times recently, and has a good success rate with with it on young athletes. I suspect the details of the surgery and quality of PT play at least as large a role as time does when considering re-injury rates. The details of technique are very likely to be critically important and experience may even be more important than graft type.

But of course, all of that experience is useless without feedback on efficacy. With so many ACL surgeries every year, you would think that there should be a better statistical basis to answer these kinds of questions. Wouldn't it be nice if your surgeon could boast a lower re-injury rate history and be able to back that up? Given the average ortho's income and the risk to our children, it seems like we should be demanding that kind of accountability here. If we had that sort of info, we parents probably wouldn't be mucking about in the details of graft type. It would all come down to who has the right formula to minimize recurrence (and perhaps other attributes).

 

[Surf Zombie]

Thought I’d share this with you all. This is my DD’s surgeon from Children’s Hospital in Boston.

https://www.childrenshospital.org/directory/physicians/m/lyle-micheli

They have a very intense and highly recommended post ACL injury return to sports program. Although it is in Boston, my understanding they offer all this stuff virtually. Going to put my DD in the program at around the 6 month mark.

ACL Injury Prevention | The Micheli Center for Sports Injury Prevention

www.themichelicenter.com

 

[dk_b]

I dunno @dk_b. Is matching the graft type you want more important than the surgeon's experience and skill level?

I think ideally you want medical advice on which graft type is best for your child, but at the same time, you also want a surgeon who specializes in that graft type, has done it hundreds of times recently, and has a good success rate with with it on young athletes. I suspect the details of the surgery and quality of PT play at least as large a role as time does when considering re-injury rates. The details of technique are very likely to be critically important and experience may even be more important than graft type.

But of course, all of that experience is useless without feedback on efficacy. With so many ACL surgeries every year, you would think that there should be a better statistical basis to answer these kinds of questions. Wouldn't it be nice if your surgeon could boast a lower re-injury rate history and be able to back that up? Given the average ortho's income and the risk to our children, it seems like we should be demanding that kind of accountability here. If we had that sort of info, we parents probably wouldn't be mucking about in the details of graft type. It would all come down to who has the right formula to minimize recurrence (and perhaps other attributes).

I am not sure we are saying anything different here - you want all of that. If there is a physiological reason why one approach is better than another for a specific patient, you want a doctor that can identify the nuance and make recommendations (that are supported by data). If a surgeon specializes in a certain approach to the exclusion of others, it begs the question (as was raised above) since not every case can fit in the same scheme (even if many or most do). The most important factors (to me) in selecting a surgeon (as I mentioned upthread) is a surgeon who specializes in pediatric athletes. Not every orthopedic does and their approach, bedside manner, etc. may differ. They are all doing a ton of cases and, again as I mentioned upthread, those of us commenting from NorCal or SoCal are really lucky because we have access to some truly exceptional practitioners.

There were very specific reasons for the two different approaches with my twins and I'm comfortable w/how we did it.

 

[Calikid]

I am not sure we are saying anything different here - you want all of that. If there is a physiological reason why one approach is better than another for a specific patient, you want a doctor that can identify the nuance and make recommendations (that are supported by data). If a surgeon specializes in a certain approach to the exclusion of others, it begs the question (as was raised above) since not every case can fit in the same scheme (even if many or most do). The most important factors (to me) in selecting a surgeon (as I mentioned upthread) is a surgeon who specializes in pediatric athletes. Not every orthopedic does and their approach, bedside manner, etc. may differ. They are all doing a ton of cases and, again as I mentioned upthread, those of us commenting from NorCal or SoCal are really lucky because we have access to some truly exceptional practitioners.

There were very specific reasons for the two different approaches with my twins and I'm comfortable w/how we did it.

Specializing in pediatric athletes is a huge plus and should be taken into consideration as a top priority. I am in So Cal and we visited five surgeons that specialized in pediatric athletes. All were trained in hamstring, patellar and quad. Four of the five recommended quad for my kid. The one who did not later admitted that the reason why they did not is because they were not trained on harvesting the quad tendon for ACL replacement.
Please do your research (read independent studies) on all of the advantages and disadvantages of all three tendons.

 

[Calikid]

Specializing in pediatric athletes is a huge plus and should be taken into consideration as a top priority. I am in So Cal and we visited five surgeons that specialized in pediatric athletes. All were trained in hamstring, patellar and quad. Four of the five recommended quad for my kid. The one who did not later admitted that the reason why they did not is because they were not trained on harvesting the quad tendon for ACL replacement.
Please do your research (read independent studies) on all of the advantages and disadvantages of all three tendons.

So basically we caught that one Surgeon fibbing in order to secure an appointment and try to convince us on a non quad tendon so he/she could perform the surgery. After all that is how they make a living. So beware.

 

[dk_b]

So basically we caught that one Surgeon fibbing in order to secure an appointment and try to convince us on a non quad tendon so he/she could perform the surgery. After all that is how they make a living. So beware.

Really sound advice. That’s why I noted that a good sign - for me - is a surgeon who does not always resort to surgery (I don’t mean in the ACL context but we have been seeing my kids’ orthopedist for a number of years, w/all 4 of my kids so our interactions with our guy spans time and variety (and gender as I have one son and 3 daughters)). Having a expert whom you can trust is just so important since, in the end, we make the healthcare decisions for our kids based on that advice (the doctors don’t make that decision). In fact, there was one orthopedic surgery on one of my kids that he did not do b/c it was not w/in his expertise. We originally saw one of his colleagues who recommended another person and he saw that as the wise/right choice even if, as a technical matter, he could have done that procedure.

 

[Dubs]

Really sound advice. That’s why I noted that a good sign - for me - is a surgeon who does not always resort to surgery (I don’t mean in the ACL context but we have been seeing my kids’ orthopedist for a number of years, w/all 4 of my kids so our interactions with our guy spans time and variety (and gender as I have one son and 3 daughters)). Having a expert whom you can trust is just so important since, in the end, we make the healthcare decisions for our kids based on that advice (the doctors don’t make that decision). In fact, there was one orthopedic surgery on one of my kids that he did not do b/c it was not w/in his expertise. We originally saw one of his colleagues who recommended another person and he saw that as the wise/right choice even if, as a technical matter, he could have done that procedure.

We saw three different orthopedists. They all pretty much gave us the same options as everyone has noted, so we left it to our daughter to decide on what Doc and what procedure. As parents, we obviously gave our input, but she ultimately chose the doc that made her feel most comfortable and we agreed. Of the procedures, she chose the one which actually gave her the longer recovery time, but had the best outlook for her in the future.

 

[Calikid]

We saw three different orthopedists. They all pretty much gave us the same options as everyone has noted, so we left it to our daughter to decide on what Doc and what procedure. As parents, we obviously gave our input, but she ultimately chose the doc that made her feel most comfortable and we agreed. Of the procedures, she chose the one which actually gave her the longer recovery time, but had the best outlook for her in the future.

Research has shown, the longer the better!

 

[Red card]

I realize this Thread has probably run its course. But I wanted to share my daughters essay about where she's at with her injury. She is 16 so please no negative comments.

 

[crush]

I realize this Thread has probably run its course. But I wanted to share my daughters essay about where she's at with her injury. She is 16 so please no negative comments.

Thank you for sharing Red Card. Tell your dd 100% prayers to her for a healthy recovery.

 

[dk_b]

I realize this Thread has probably run its course. But I wanted to share my daughters essay about where she's at with her injury. She is 16 so please no negative comments.

I think she captures a lot of the feelings many of our kids have felt. Thank you for sharing that.

(I ended up not posting on this thread but my kids' doc sent me a few articles regarding return-to-play and they are pretty clear on the data of reinjury rates for those who return to play before 9 months and those who return after 9 months. Obviously not all athletes will reinjure - in fact, most won't - but a 1-in-3 chance v 1-in-20 chance is powerful evidence for me to be an advocate of my two kids waiting)

 

[crush]

I think she captures a lot of the feelings many of our kids have felt. Thank you for sharing that.

(I ended up not posting on this thread but my kids' doc sent me a few articles regarding return-to-play and they are pretty clear on the data of reinjury rates for those who return to play before 9 months and those who return after 9 months. Obviously not all athletes will reinjure - in fact, most won't - but a 1-in-3 chance v 1-in-20 chance is powerful evidence for me to be an advocate of my two kids waiting)

Excellent sage advice again. We need your help bro. It's the pressure to NOT get hurt because of this and all of that, and what that is for each kid and her family is different but the pressure remains the same. The kids should just be playing soccer for fun. I bet less injuries? 3 games in a row seems way too much for these dds of ours who feel the pressure. I hope we can find easier ways to get a deal done to play college ball.

 

[Red card]

I think she captures a lot of the feelings many of our kids have felt. Thank you for sharing that.

(I ended up not posting on this thread but my kids' doc sent me a few articles regarding return-to-play and they are pretty clear on the data of reinjury rates for those who return to play before 9 months and those who return after 9 months. Obviously not all athletes will reinjure - in fact, most won't - but a 1-in-3 chance v 1-in-20 chance is powerful evidence for me to be an advocate of my two kids waiting)

thank you. im personally pushing for a longer recovery.

 

[NorCalUSN]

I wish the clubs or maybe the GA/ECNL could enact/follow some kind of protocol about return to play post ACL. I know it's a pipe dream. Maybe they have something. Reading how some of these clubs care about the financial bottom line I would think they would want something like that to protect them from liability.
Personally, I am of the mindset nothing remotely play-related until at least 9 months. My daughter recently passed her 100th day post op and her Surgeon said she is well on her way to meeting that 9-month mark. She is much more mature and level-headed about the risk/reward of premature return to play, (better than I would have been). My wife and I are also a lot more conservative on this milestone and have little problem holding her out to the 12 month mark or longer depending on advice from both the Surgeon and the Physical Therapist.
However, I really feel sorry/concerned for some of the girls out there who feel the pressure of early return to play.
This weekend my wife tells me "(Daughter's name) saw girl from Club NAME who returned to play at six months, on instagram." I know we often talk about the power our daughter's coaches have, but in this case I wish the coaches would push back and tell these parents/kids to wait. (Don't get me started on the annoyance and influence of Social Media)
Yes, I know circumstances for an 17/18 year old hoping for that best last look at a showcase are different than that 14/15/16 year old. But for a lot of these girls perception is reality. If they think they are going to get passed by or overlooked during their sophomore year it is going to become all too real.
To summarize I really hope parents understand the pro/con matrix of early return to play, I hope they do their research and make informed decisions about their daughter.

 

[supercell]

The problem with strict timelines whether long or short is that they don't factor in all the variables that people have. The specifics of injury, surgeon's technique, graft type, the athlete's confidence level, and most importantly, the specifics of rehab are all huge factors. Radical reconstructions and/or poor discipline during PT may stretch recoveries dramatically. ACL tears with no complications and a young motivated athlete with good training will generally return to play earlier.
IMO functional testing combined with your physical therapist and surgeon's experience should determine the right time to return to play. No blanket timeline imposed by a league or coach can possibly advise you on this accurately, nor should they.

 

[oh canada]

I realize this Thread has probably run its course. But I wanted to share my daughters essay about where she's at with her injury. She is 16 so please no negative comments.

This thread will never run its course, unfortunately. It is one of the most important threads of this forum. Tell your daughter this teacher thinks her writing is great work! Do you mind sharing...which game/day of her three did it happen?

 

[Surf Zombie]

My 2007 9th grader just tore her ACL in a game. Essentially half way through her HS season. Cleared a ball with her right foot and as she was bringing it back down slipped on the wet turf and her knee twisted awkwardly.

We are In the process of scheduling surgery. Will miss the rest of her HS season and probably all (most?) of her ECNL season which is early December-late May.

Anyone else been through it and have any tips on the recovery process? She made it from U8 until now without ever being injured, so it’s going to be a big adjustment I’m sure.

My DD is 3 weeks post surgery today. First two weeks were really tough. Lot of pain.

Her team had their first two post high school games this weekend. Was great for her to get out to the games and get to feel like part of the team. Hope everyone else who has a kid going through this is heading in the right direction.

 

[Red card]

This thread will never run its course, unfortunately. It is one of the most important threads of this forum. Tell your daughter this teacher thinks her writing is great work! Do you mind sharing...which game/day of her three did it happen?

i wasn't there. i think it was the second game. Thank you, I thought it was a good essay too. I suggested to her to blog her experiences maybe help other girls or even herself.

 

[NorCalUSN]

i wasn't there. i think it was the second game. Thank you, I thought it was a good essay too. I suggested to her to blog her experiences maybe help other girls or even herself.

My wife, my daughter's best friend/motivator/trainer/coach keeps a journal as well. In addition to coordinating her Physical Therapy, taxi service and homework completion they take a photo of her knees almost every day to show her progression.

 

[Surf Zombie]

Not interested in rushing my DD back onto the field, but have a return to play question.

Her ECNL season ends late May (which will be 6 months post surgery) and her sophomore HS season starts early September (10 months post surgery). I don't expect her to play (meaning without restriction in a real game) until the HS season 10 month post surgery mark (if everything goes well).

That said my question is at what point post surgery did your DD's start jogging/running/doing non-contact ball work? My DD's surgeon said she will likely be cleared to do those things at the 3 month post surgery mark. Just curious if that is a typical or atypical timeline. Thanks in advance.

 

[supercell]

Not interested in rushing my DD back onto the field, but have a return to play question.

Her ECNL season ends late May (which will be 6 months post surgery) and her sophomore HS season starts early September (10 months post surgery). I don't expect her to play (meaning without restriction in a real game) until the HS season 10 month post surgery mark (if everything goes well).

That said my question is at what point post surgery did your DD's start jogging/running/doing non-contact ball work? My DD's surgeon said she will likely be cleared to do those things at the 3 month post surgery mark. Just curious if that is a typical or atypical timeline. Thanks in advance.

That's pretty similar to my dd's timeline. She was running in the aquatic treadmill at 2 months and on the regular treadmill at 3 months. She didn't do anything with a ball until 4 mos though.
The timing of your daughter's seasons sounds pretty fortunate with first game possible at 10 mos or more.