Thursday, May 05, 2011

ACL Diary: Patellar? Hamstring?

“Go With Your Gut”
The first thing we learned is that shredded ACL ligaments cannot be repaired. They may, however, be reconstructed. It wasn’t until we saw the MRI images and our surgeon pointed out the barely visible frayed remains of Willow’s ACL, that we truly understood.

Options for ACL reconstruction surgery presented to us were:

Given Willow’s desire to return to competitive soccer, Dr. Tucker ruled out allograft, indicating it was not the strongest option. He then explained the patellar and hamstring tendon techniques, citing both as viable options, and listed the advantages and disadvantages attributed to each.

So then it was left to us to decide. And this is what occupied my brain for the next several days:
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?
Patellar? Hamstring?

Two friends here in Tucson, both nurses, have daughters who had been Willow’s teammates in the past, and had torn their ACLs. When they learned of Willow’s injury, they made a point of contacting me to offer advice, opinions and especially moral support. In fact, they both said to me—one through email and one on the phone—“I know EXACTLY what you’re going through.” Even though I didn’t realize I’d soon become a bona fide ACL reconstruction procedure “expert” on a par with them, they made it immediately apparent that both my daughter and I would survive this ordeal.

District Champion Bobcats, Cass and Wills, 2009

Like Dr. Tucker, these fellow soccer moms discussed the options available to us and didn’t necessarily recommend one procedure over another. Of course they shared the methods they chose, which included both patellar and allograft, but they encouraged me to do my own research, and go with my gut.

The nurses weren’t the only soccer moms and/or dads who contacted me. Parents of other teammates—past and present—who have faced this, and friends from high school and other former lives offered empathy and information.

As my source list grew, so did my research folder.

In short, my research showed that even though the patellar surgery was once considered the gold standard, with recent improvements to the hamstring technique, it’s close to impossible to find anything or anyone that can or will objectively recommend one procedure over the other as being “better.”

95 Rush Team, 2006-07 . . . Four Future Knee Surgeries

Even after factoring in gender and body type, ultimately our choice became an exercise in choosing among the DISADVANTAGES.

With the patellar what stood out was the potential for long-term frontal knee pain and the possibility of future patellar fracture/injury; and with the hamstring we understood a risk of the tendon stretching and thereby causing re-injury.

It wasn’t long before I threw my hands in the air and prayed out loud for someone to “tell me what to do!”

And then, someone did.

I phoned a Sports Medicine physician in Wisconsin, Dr. James Mullen with Premier Physical Medicine and Wellness Clinic, to tell him about the injury. (Willow trained with him in a speed and agility course all last summer). Dr. Mullen is a six-time member of the U.S. National Speed Skating Team and an inductee of the Wisconsin Soccer Association Hall of Fame.  He also has multiple top 200 American Birkebeiner finishes (x-country skiing marathon) and still actively races.

When I told Dr. Mullen about Willow’s injury, he couldn’t help but express his disappointment given that last summer’s training was all about ACL injury prevention (ugh!) And before I even asked his opinion regarding the procedures, he advised us to go with the hamstring replacement for Willow.

“Hamstring has gotten a bad rap in the past,” he said, “but today the surgery includes braiding of the tendon to make it stronger, as well as a vastly improved reattachment technique. There’s far less of a chance of stretching.” Mullen went on to say that it would be the surgery he’d chose for himself.

Can you guess how many surgeries these girls represent?

The athletic trainer at Sabino High School, Connie Rauser, who conducted a drawer test on Willow and used her knee as the subject of one of her sports medicine classes, was, like Dr. Tucker, certain of an ACL tear. She, too, recommended the hamstring replacement surgery.

Finally, it was Willow herself who decided hamstring was the way she wanted to go. And as she so often will remind me that this is HER life, in the case of her torn ACL and replacement surgery, she was quick to point out as well that this was indeed, HER knee.

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1 comment:

Anonymous said...

I am curious to the outcome of Willow. I have gone through 4 acl surgeries. The hamstring has not worked for me. I hope she has had successful return and stays that way for many years.