ACL Diary: Clearing Hurdles

The Surgery Itself

Willow’s ACL tear happened during the first game of the 2011 AZ State Cup, which is the last tournament of the season, and the most important in terms of establishing team ranking. She was also in the midst of her school track season and had just posted her best time, three seconds off the previous week. Her event? 300 Hurdles.

Little did she figure on a whole new set of hurdles ahead of her that would cover a span of months rather than yards.

Clearing the hurdle over selecting what type of ACL reconstruction surgery to have, the next hurdle was scheduling the procedure. Dr. Todd Tucker, who we believe is the surgeon of choice for hamstring replacement in Tucson, had an opening on April 21. This was Willow’s first day of Spring Break, and at first we thought it was good timing, considering she’d miss fewer days of school.

Willow is a serious student, enrolled in demanding classes. Missing school might be considered a bonus to some kids; however, to Willow, who ultimately only missed two days, finding time for makeup work (particularly lengthy trigonometry problems) was an additional stressor we didn’t foresee. It nagged at me that we possibly should have waited until the school year ended; however, given our back-and-forth lifestyle (Tucson-Wisconsin-Tucson-Wisconsin-Tucson-Wisconsin) we decided to have the surgery here in Tucson—rather than during the midst of our busy season at Sandy Point Resort. Plus, Dr. Tucker wanted at least 4-5 weeks to monitor Willow’s initial post-surgery progress.

So, with an ETD for Wisconsin of May 26, we counted weeks on our fingers, and scheduled the date--April 21.

Mike and I were as worried as any parents of a child undergoing general anesthesia and the knife. Willow, on the other hand, was resolved. She may have simply believed that the sooner she had the surgery, the sooner she’d get back on the field. We were blessed to have a good friend, Karen Schwartz—aka KK—as her intake nurse at the Tucson Surgery Center. Her high beam smile and natural warmth eased us into the process.

KK and Wills in the recovery room

As she and the anesthesiologist prepped Willow, Dr. Tucker told us to expect the surgery to take 1-1/2 to 2-1/2 hours. He, of course, knew what to expect with the ACL, but he wasn’t certain about the meniscus. Since 50% of these injuries tend to also include meniscus damage, and the MRI wasn’t definitive, he wouldn’t know until he got in there. His plan was to repair the meniscus if necessary, or remove any damage if determined to be insignificant.

Granted, 1-1/2 to 2-1/2 hours wasn’t a large stretch of time in the waiting room, but timing is everything when running hurdles. One needs to know when to expect the next jump—right down to the millisecond.

I passed the time doing the Thursday Merl Reagle crossword and the Suduko puzzles in the AZ Star, while Mike went to Starbucks for his nineteenth nervous non-fat latte.

And then, merely an hour after we watched Willow wheeled away, Dr. Tucker came into the waiting room. He spotted us at once and a smile filled his face.

All I can say is that at this moment, our hearts leapt.

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:

• Patellar Tendon 
• Hamstring Tendon
• Allograft (Donor Tissue)

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.