This 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…
Rehab/strengthen the knee as much as possible (pre-surgery)
Choose the type of ACL surgery you want (graft and fixation choice)
Choose a doctor
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.
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.
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.
Did you know that right now you have an asset that is so valuable, it far surpasses any amount you have in your IRA, stocks, mutual funds, business investments, your real estate, cars and all your possessions put together. It is worth far more than a billion dollars and you already own it. What possibly could this be? It’s your body. That’s right, your physical human body is a priceless asset and we can logically prove it.
Have you ever met a multi-millionaire or billionaire? How about one who is disabled? A wealthy person may be blind, may only have 1 leg, or may be paralyzed and dependent on a wheelchair. If you were blind, and if you had the option of paying 1 million dollars to be able to see again, if you had the money, would you do it? How about 10 million, or 100 million, or 1 billion? Most people would gladly trade money for part of their health back at any price, because your body is priceless.
The same goes for legs to walk again, or vocal chords to sing or talk again, or hands to work and help others. You’d better believe that right now if one of these disabled people could, they would be glad to give you millions or billions of dollars to be able to have your physical ability you may have right now. If you can walk, talk, see, hear, smell, taste, touch, and are in good health, then what you have now is so valuable you cannot put a price on it. If you had a cash register ringing up each of the valuable body parts you have, you likely would run out of digits. So, you can logically conclude that you are an extremely expensive and priceless human being.
Most people treat professional athletes, thoroughbred horses, cute dogs, cats, and pets, with extreme care and respect too. You would want them to exercise regularly and keep on a carefully planned and monitored diet for premium performance.
So, why is it that many people take their most valuable asset, their health, and put it at risk by avoiding exercise, not getting enough sleep, feeding it junk food, candy, preservative chemicals, alcohol, poison, and inhaling carbon monoxide? Some people say it’s so inhumane to clip a cat’s toe nails, but the same people can grossly mistreat themselves without even seeming aware of it. Is this done because people really think they’re better off subjecting their bodies to abuse, or is it a lack of self-control, or perhaps is it because advertising, culture, and peer pressure tells them that’s normal?
If you like smoking, please take a moment to consider the pros and cons. Have you logically sat down with a piece of paper and decided that you are overall better off and will be a happier person and have a more enjoyable life if you smoke? Have you ever met a goal-oriented person who has set a goal to someday start smoking so they could enjoy their life more? If it is truly a worthwhile and beneficial activity that non-smokers should have, then why don’t we see people coordinating, planning, hoping, and looking forward to achieving it?
Most people consider the 2,996 people who died in the September 11, 2001 attacks against the U.S. a tragedy. But what about the 419,000 premature deaths in the U.S. caused by smoking every year? (source: American Cancer Society) That is like having 140 September 11ths in the U.S. every year. So, in ten years, that is more than 4 million people who get killed, or nearly 1,400 September 11th attacks. And that is only in the U.S.
In the world, instead of taking 10 years to kill the that many, 4 million people perish every year from smoking (source: World Health Organization [WHO]). That’s 1,335 September 11ths every year, worldwide. And we not only allow the attacks and allow people to get killed, we actually promote the attacks from our countries allowing cigarette companies to advertise. About 1 billion people in the world are smokers, and the smoking consistently kills half of its users. That doesn’t seem very promising if you’re considering starting smoking! But unfortunately, this message hasn’t been received, because smoking is on the rise and WHO predicts up to 8 million deaths (per year) by 2030. Tomorrow another 11,000 will die from smoking. Then another 11,000 after that, and we’ll continue to have 3 1/2 September 11ths disasters every day, from today until the rest of the year, and we’ll watch it increase until more and more people die. What a complete, utter tragedy, that is continuing on and on. Smoking has caused millions more deaths than the holocaust, and far more than any war in the history of the world. But this tragedy isn’t in the news much. People might rather hear about the lost baby in Florida, or a sex scandal in D.C., than the 11,000 that will die tomorrow.
It’s ironic that the teens and young adults who start smoking begin because it feels cool, independent, and rebellious, but that idea was a socially-manufacured idea from the cigarette companies. They basically had a product that was addictive and killed people and were trying to figure out how to get people to use it. So, through advertising, they brainwashed people to accept the toxic product as being cool, and it worked! So, instead of the smokers being liberated and feeling independent, they’re actually mindless puppets of a corporate-invented social experiment, and later become slaves to addiction.
Consider trying to take charge of your health and disregard other people who pressure you into killing your body with cigarettes, drugs, and alcohol. It’s not worth the temporary feeling of friendship or social acceptance. These friends may come and go, you still be stuck with your same body and whatever harm you have caused it until the day you die. Take care of it and you will feel better, happier and healthier. Your body is too precious of an asset to jeopardize.
If you have an accident and hurt yourself, such as your knee that may require ACL surgery, do everything possible for a strong recovery. Treat your body like a multi-million dollar thoroughbred race horse, working and training hard for a successful recovery and maintain a body that will perform well and last a long time for an enjoyable life. You deserve it, even if you don’t feel like you do right now. You will thank yourself later. See you at the finish line!
Many 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.
People can tear their ACLs in a variety of ways. It can occur from high impact sports like motocross or karate, or doing mundane things like walking down stairs or hopping out of bed. Videos actually show athletes tearing their ACLs, not for faint of heart, but give you an idea of how it happens and what it’s like.
How most people tear their ACL (From December 2010 survey)
The ‘other’ group contained random activities, such as:
Training with marines
Jumped off truck tailgate
We look forward to hearing your story on how you hurt your knee…
Choosing your doctor (the surgeon) for your ACL surgery is in important step in the process. It can be overwhelming trying to decide who you should put your trust (and money) in for this once-in-a-lifetime (we hope) surgical procedure. You will likely work hard in pre and post-rehab and the last thing you want to do is choose some bozo doctor who is inexperienced and does a mediocre job. There are horror stories out there and you don’t want that to be you! You only have one set of knees and you want them to last for your lifetime. So, how do you decide who to choose? I assume you live near a city that has a variety of doctors to choose from. So, assuming you have a large pool to select from, the most important step is narrowing it down to the right person. Below are a few ways you can narrow down the prospects.
Narrow down by graft or fixation type
Doctors tend to have distinct areas of expertise and tend to do procedures they’re comfortable with. It’s uncommon for a surgeon to perform both patellar grafts and hamstring grafts, for example, it’s normally one or the other. So, when you choose your doctor, it essentially decides what type of graft and fixation technique. Therefore, it’s best to make sure you have already chosen what graft you want first. This will then narrow down prospective surgeons.
Narrow down by location
Another way to narrow it down is by location. How important is it that you have the surgery as close to where you live as possible? On surgery day, you’ll need to have someone drop you off and give you a ride back. It may not be feasible for some to drive 2 hours or more to a big city. So, this may limit the pool of surgeons as well.
Narrow down by expertise
You can narrow surgeons down by expertise as well. Make sure they are board certified with the state and have all the normal credentials. Maybe the surgeon has a few feathers in his cap from special research or techniques he or she has pioneered. Some people want reputable surgeons that are on-staff surgeon for a professional or college sports team. Pro sports teams likely would do extensive research and choose only the best surgeon for their team, so you could piggyback off their selection criteria.
Narrow down by reputation (websites)
Another option is to search for a doctor’s reputation online. Several sites exist, but there are none that are 100% adopted by everyone yet. You probably want to avoid sites like angieslist that require payment upfront and have no guarantee of any kind of useful content. The best site for the time being seems to be: http://www.healthgrades.com Go there, type in a doctor’s name and see if it has any info.
Narrow down by choosing ‘preferred providers’
Your health insurance company may have a preferred providers list on its website that are guaranteed to successfully process payments through your insurance company. This is an important step as you don’t want to risk having the surgery and find out the provider is ‘out of network’ because of some technicality, forcing you to spend thousands more dollars.
Hopefully this list helps you fine tune your list of candidates for performing your ACL surgery. If you have additional criteria that helped you decide, please share below in the comments.
ACL surgery is expensive and plays a large role in the decision of whether or not to have surgery. Insurance companies and coverage varies. It’s wise to get the exact billing codes from your doctor and give these codes to your insurance provider to see if its covered in your plan. Be as specific as possible, for example, besides the codes, note the estimated duration of the surgery, if the doctor will have an assistant and if billed individually, and the anesthesiologist, physical therapy rehab, ice machines (cyrotherapy), leg braces, crutches, pain killers or any other prescriptions, and any other costs. Get it all and be detailed so you don’t have any surprises.
Has 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.
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…
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.
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.
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.
Choosing 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: