The Long Hot Summer Recovery Process

Bruce Valentine working with Willow in June

According to Tucson’s best and Willow’s favorite physical therapist, John Woolf, Willow is rockin’ it as she recovers from her ACL replacement surgery. Because of her hard work over the summer in Wisconsin with two different physical therapists, a certified trainer and a sports medicine physician, AND her good-girl behavior (staying off the waterski / wakeboard and not running), she’s right on schedule to get back to soccer.

Upon returning to Tucson in early August, she saw her surgeon, Dr. Tucker, and he cleared her to begin straight-line running. She had aspirations to return to the Sabino x-country team; however, that was a “no,” due to the uneven surfaces inherent to the sport. She has attended a few club soccer practices, but can’t yet do much with the team.

It was tough not being one of the girls at their level, but she was happy to see everyone and hopes to reestablish those tight bonds. This afternoon we’re looking forward to watching a scrimmage between her team and the UofA club team.

So now that the flex and extension are there, the weight and strength have returned, it’s time to focus on getting back in condition. That’s a little tough while Tucson is experiencing record high temperatures (we’re talking about 109°--and it’s muggy!). Willow works out with her therapist twice a week, however, she needs to get on the track and we’d like to have her up-to-speed by her next surgical appointment, which is exactly five months from the date of surgery: September 21. At this time Dr. Tucker expects to clear her for soccer.

“I won’t be able to play at the high-impact level I was at before,” said Willow. “Yet.”

But at least she’ll be out there. And with her sense of determination, soon the big blonde girl known as “The Bruiser” will be back. 

Please keep all your fingers, toes and knee ligaments crossed.

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.

ACL Diary: Making Choices

"Someone, Please Tell Me What To Do!"
One of the complications of living in the United States, and I’ve often made this observation when facing a big decision, is that there’s far too much choice. I may have first had this feeling when doing something as trivial as walking down the cereal aisle at the grocery store. Looking at an overwhelming wall of some 500 choices of commercial brands alone—and who knows how many generic—more often than not, I still end up choosing the tried-and-true yellow box of Cheerios.

There aren’t as many orthopedic surgeons in Tucson as there are brands of cereal; however, I’d say there are at least a hundred, and since we know several girls who had torn their ACLs and had repair surgery, personal referrals were quick to arise. (By the way, EVERYONE thinks his/her surgeon is a rock star!)

When considering credentials, you must decide whether or not your child should still see a pediatric surgeon, and this may be based on the state of her growth plates. The x-rays we took at Urgent Care showed that the legs of my 16 year-old, 5’-9” daughter would not grow any longer—growth plates decisively closed—and therefore we chose to treat her as a “level one athlete” rather than a child. This led us to consider surgeons specializing in sports medicine. And naturally, we wanted a surgeon who’d already accomplished many, many ACL repairs.

One of the surgeons whose name was high on our list—we knew two girls who’d recently been his patients—had an early afternoon cancellation two days after Willow’s injury. Wanting some immediate answers, we jumped on that appointment. Dr. Tucker (and his fellow), each gave Willow what’s known as a “drawer test,” to determine the nature of her injury. Tucker was certain he was looking at another torn ACL, but regardless, he gave Willow odds prior to scheduling an MRI.

This was her Facebook status update after the appointment.

Willow Cozzens

Soo 75-90% chance it's my ACL. in my mind that means 10-25% chance it's not. 
LET'S HOPE I BEAT THE ODDS




Willow didn’t beat those odds, bless her heart. And as a result, we had to make another major decision, and that was what type of ACL repair surgery we wanted to use. And this was, perhaps, the most difficult choice we had to make.

ACL Diary: And So Begins the Rehab

Thursday, April 28, 2011

From the moment my daughter went down on the soccer field, my guts told me what we’d be facing. But there wasn’t any way to truly prepare for the emotions her ACL injury would invoke. It has been just shy of a full lunar cycle since the incident—26 days—only one week out of surgery, and already I feel like a seasoned veteran of the course that is the treatment of an ACL injury.

Since 220,000 female athletes under the age of 21 face this specific injury each year, and I have personally now witnessed too many of these plant-twist-pop-collapse episodes to count, I believe it’s important to document our experience. Those with children who have torn their ACLs will relate and empathize, and those who are at the very beginning of this journey toward repair and rehabilitation will hopefully appreciate and learn from our experience. (ACL stands for Anterior Cruciate Ligament, which is one of the four major ligaments in the knee). And if you're the parent of an athlete—especially a soccer or basketball player—please take note of the statistics and add ACL prevention training to your kid's regular workout.

We are filled with gratitude for so many friends who have helped us through the process so far. For a while, it seemed as though a day didn’t go by where I didn’t hear from or learn of another young athlete who had torn his/her ACL. It’s sad how many we know, but also knowing we’re not alone has been healing in itself.

First of all, in case you haven’t been on the sidelines of a thousand soccer games, I’ve compiled a very brief video with three examples of the typical defensive move made by Willow (#24) during any given game, which was the same move that led to her injury. These clips show her chasing down the ball and/or offensive player with the ball, successfully taking possession and changing direction.

This next video, which is still painful for us to watch, shows the same sort of run up the sideline, but this time Willow was NOT successful. She turns on her right foot, but her left gets caught up on the leg of the player she’s marking, and she goes down. According to her surgeon, Dr. Todd Tucker of the Tucson Orthopaedic Institute, Willow didn’t just tear the ACL on her right knee, “she shredded it.”

Day 1: April 2, 2011

Arizona State Cup, Game 1

TVSC 95 Samba vs. 95 Valparaiso

Golf Links Field D, Tucson, AZ

Many of us suspected and even knew we had just witnessed an ACL injury. Team dads, LaMonte Hunley and Tony Guerrero (whose own daughter suffered an ACL tear some three years ago), carried Willow off the field and brought her to the arms of team mom/athlete, Shannah Biggan, and another teammate, the lovely Olivia Ortiz—also recovering from ACL surgery. I ran to get ice and tried to breathe rather than hyperventilate. I also called my husband, Mike, who was in Prescott with Camille and her soccer team, and broke the bad news.

When I returned to the sideline, Willow was as upset about the pain in her knee as she was about not being on the field, and letting down her Samba teammates. But there was no way Willow was going back in that game.

Samba lost 0-1.