ACL Surgery

ACL SurgeryThis ACL Surgery site provides real, unbiased, useful information about cost, recovery time, rehab, insurance issues, choosing a surgeon, and most everything related to making the decision of having ACL surgery.

It was created by people who actually had ACL surgery (anterior cruciate ligament) and needed more details to help make a more informed decision. Learn from the mistakes and successes of others and enjoy your visit! Now, scroll down to view the 8 key steps BEFORE having ACL surgery…

8 Key Steps Before Having ACL Surgery:

  1. Talk to a doctor
  2. Get an xray and MRI
  3. Rehab/strengthen the knee as much as possible (pre-surgery)
  4. Choose the type of ACL surgery you want (graft and fixation choice)
  5. Choose a doctor
  6. Get billing codes from your doctor for each specific component of the surgery, approx hours in surgery, location (address), and get their estimate of costs assuming you had no insurance.
  7. Have a thorough conversation with your health insurance company (if you have one) to learn how much % your insurance will cover you. Fully document the questions, answers and conversation.
  8. Now that you have cost information, you are able to make an informed decision on whether or not to have the surgery.

Important Note: there’s no risk in waiting if you are careful. The surgery itself won’t be more or less successful if you wait 5 – 10 years. The only risk is if you try to do sports or activity on an unstable knee and injure it worse. Some people, through lots of strengthening of surrounding muscles are able to compensate for the vulnerability and not have the surgery.

If you do have surgery, wait at least 6 months after your incident. The reason is that the knee sometimes takes months for swelling to go down, for full range of motion to return, and to re-strengthen the muscles. You don’t want surgery if you are still healing from the incident. When in doubt, postpone.

If this is the kind of advice you’re looking for, check out the ACL Surgery Cheat Sheet. It has everything you need to know about your ACL surgery options and could save you hours of research.

ACL Surgery Successes and Failures

Wrestling ACL SurgeryMany athletic people and professional athletes sustain a painful injury to the Anterior Cruciate Ligament of their knee and have several options for rehabilitation including surgery choices. If the patient is not intending to return to athletics and wants to commit to physical therapy options and doesn’t want surgery, it is possible to regain use of the knee again for normal living. However, the majority of patients want full use of their knee to return, will not consider a life without action and sports and therefore choose surgical repair. The most common sports to cause ACL injuries are: Soccer 23.5%, skating 13.7% and basketball and football both at 11.8%.

There are three primary choices of grafts for ACL surgeries: patellar grafts, hamstring grafts, and allografts (cadaver grafts). There is much speculation and debate about which graft and fixation is the best. Surveys show that the hamstring graft is the most popular choice currently for most people, but that the most serious athletes in competitive sports still choose patellar grafts, known for being the strongest, most reliable graft, but not necessarily the most pain-free.

The best advice before surgery is to wait at least six months to allow the swelling to abate, with full range of motion to return and pre-surgical strengthening exercises preparing the way. After surgery, the need to work with a physical therapist and/or athletic trainer is crucial. It will also take a full year for the proprioception to return which is the balance and agility factor, so important to keep from re-injuring the knee.

Out of 400,000 ACL surgeries a year, about 18,000 to 35,000 (4% to 9%) fail is some way. The most common failures are permanent stiffness; lack of full extension and range of motion; instability and a pain and/or grinding. The reasons for failure include going back to sports too soon; not completing proper post-operative care with a brace or cast; and several possible surgical errors. The graft may have been misplaced, non-anatomically correct, too vertical or too tight. The rehabilitation program may have been poorly designed or the patient had lack of motivation to succeed. Whatever the reason, the condition is called “arthrofibrosis” and this failure will lead to post-traumatic arthritis.

Some patients had successful surgeries and rehabilitations, but end up reinjuring the knee either playing the same sport that caused the original injury or from other activities involving twisting motions of the knee. Whether through carelessness or by accident, the resulting knee injuries will be more complicated, less stable, and require even longer rehabilitation. Most professional athletes are forced to retire after reoccurring knee injuries.

Remove Screws After ACL Surgery?

remove screws acl surgeryHas anyone had their hardware removed (screws, etc) after having ACL surgery?

I’m currently scheduled to have my 2 titanium screws removed from my my incision, just below my knee. It isn’t the bioabsorbable screw, as that is not wise to remove, being deep into the bone. The surface area with the 2 screws is sensitive, but is only minor pain- probably a 2 on a 10 point scale. With my insurance deductible met, I’m tempted to have the screws removed, but I don’t want unnecessary risk.

Read more about Removing Screws

Advice from my ACL Surgery

Would you like to learn from someone else’s knee surgery experience? This is a summary of what I learned through my ACL surgery (which took place in February of 2009):

  • Yoga is an excellent way to build strength and balance prior to surgery- something that I reaped the benefits of post-surgery, because there’s a lot of hobbling around in crutches and balancing on one leg while reaching down and picking up things
  • Wait a while before the surgery. It took 6 months for my swelling in my knee to go completely down where I regained most of my motion back and was able to do strength exercises. The surgery is said to be more successful after all the swelling subsides. Just be careful in the mean time to not reinjure yourself, and it will be worth the wait.
  • Ice machines are good if you have people around to help maintain it. They run out of ice quite often, every 1-2 hours. So, unless you have people helping you with it, you won’t get much rest constantly getting up to fill the machine with new ice and drain out the old. Crushed ice is worst, regular size ice is mediocre. The longest lasting is homemade ice in 16oz cups- denser- and still fits in container- it may last 3-4 hours each batch. There’s also an electrical shock hazard on the Game Ready ice machine I had. Water from the drainage may leak onto the AC outlet underneath. What were the product designers thinking?
  • Try to avoid hopping on one leg with the other one dangling within a week after surgery. I suspect this and other extra movements led to me having some extra pain and internal bleeding- which they had to manually drain with a needle 1.5 weeks post-surgery.
  • A wheelchair is not a bad idea, as an alternative to get around in your home.
  • For rehab, it’s better to listen to your body (pain level) and let that dictate the speed of recovery rather than follow a physical therapist’s recovery timeframe to a T. It’s ok to take the exercises slow- there’s no rush.
  • It’s nice to have a cart on wheels. One that’s not tippy. You can put dinner plates on it, and roll items from the refrigerator to the table, or for moving your heavy ice machine around, etc. Otherwise, it’s a challenge moving objects around the house with crutches.
  • Don’t try to touch toes to put on/off socks- I may have pulled my hamstring doing that.
  • Don’t pay your bills too soon! Wait until absolutely everything is resolved between your providers and insurance company first. You don’t want to start paying bills you don’t owe. There’s a degree of negotiation between the provider and insurance company and it’s best to postpone paying until everything is settled and knowing that you’re not getting jipped- it puts you in a better position to negotiate in case your insurance didn’t cover something they were supposed to.

Post ACL Surgery Timeframes:

  • Same day: went home and used crutches to get around
  • 1.5 weeks – stopped using the ice machine full time, much of the swelling gone
  • 2.5 weeks – started driving (very carefully) and went completely off pain pills.
  • 3 weeks – less dependent on the knee brace- went without it- and start walking.
  • 3.5 weeks – able to climb/descent stairs
  • 4 weeks – started walking without crutches, able to use stationary bike and do light squats

Insurance companies will harass you and will try to find any loophole possible to not cover your benefits. As tedious as it is, it’s best to speak to the billing department of each of your service providers in advance and get price quotes and take good notes with who you spoke to, dates, billing codes, time spent on each procedure, etc. Then speak to the insurance company and ask them based on this scenario what your coverage will be. They are trained to be extremely vague about everything, so it takes some work. Take detailed notes on everything.

How much does ACL surgery cost?

I got a couple quotes (before insurance coverage) and here’s the range…

Surgeon fee – $1,350 – $2,200
Facility fee – $810 – $9,300 (huge range!)
Anesthesia – $748 – $845
Implant fee – $500

Other fees:
Full knee brace – $490
Ice machine rental (2 weeks) – $300 (not covered by insurance)
Prescription pain medicine – $100
Crutches – $30

Get more info on ACL Surgery Costs

If you are having a hard time with the cost aspect of ACL surgery, there’s nothing wrong with shopping around and choosing a different doctor. You can even travel to a larger metro area if its important enough.

Insurance issues

My insurance is supposed to cover 80%, but with the deductible, 20%, and some things not covered, when it’s all done it’s supposed to be $2,000 – $3,000 to me. That’s a little too vague of a price range for my comfort, but that’s part of the billing game.

It’s 5 weeks out and my insurance company is playing the game, saying initially that my benefits are denied, while requesting an ‘incident report’ form to be filled out. Basically, they’re trying every possible scenario to get out of paying, fishing for someone else to be potentially liable for the incident. I think they’ll have to pay though, according to the conditions of the plan.

Provider issues

The providers are also a little tricky in the way they bill. For example, they quoted me only the surgeon’s fee each time I asked about billing with no mention of any other weird fees. But now that it’s over, they decided to bill separately for one of the assistant’s time too. I would have wanted him out of the room if it were up to me- it would have saved $490.

The providers also quoted me one rate and billed another- higher $ of course. They also said the prices will be going up after the new year, which may be reflected in my bill. There’s really no guarantees of anything and the patient is in a very poor position for negotiation.

I hope this information helps someone. I wish I had this kind of info beforehand.

Remember to also read everything on this site and read the ACL surgery tips and comments from other people.

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Learn about the decision of which graft to get: Patellar vs Hamstring

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Patellar vs Hamstring

Patella vs Hamstring for ACL sugeryChoosing between patella vs hamstring as a graft for ACL surgery can be a difficult decision. At a glance the options seem fairly balanced, with pros and cons on either side, but our two polls have shown a slight leaning toward hamstring graft. Below is what people commonly say among the choices:

Read more about Patella vs Hamstring