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Bob's ACL WWWBoard
Re: Level Of Evidence: Skill of Surgeon/Graft Type Ranking
Posted By: TC
Date: Monday, 11 January 2010, at 3:53 a.m.
In Response To: Re: Level Of Evidence: Skill of Surgeon/Graft Type Ranking (drmark)
> Everyone who reads my posts must first click on my username
> and read my profile.
> I have been reading these studies for over 30 years and
> agree with you, but have found that some things keep coming
> through that have and have not what to do with
> surgical/rehab skill.
> Early complications such as flexion contracture, missed
> placed graft have all to do with surgical skill and are
> rare to nearly nonexistant in skilled hands.
> Late complications like attritional rupture of an allograft
> have nothing to do with the installation.
> Hope this helps
Yes it does.
What would you say accounts for different outcomes with patients with similar injury using the same type of graft? I just ran into two people, one a friend who had a patella autograft two years ago and after the initial week had no pain, no kneeling pain and no tendonitis and said he barely did his PT. The second individual also had a patella autograft and said the pain was unbearable for two weeks, and severe for 4 more weeks and difficult through 5 months of PT which he said he did religiously. He said he still has kneeling pain 1.5 years later and occassionally his knee is sore. Two different doctors (FYI neither of them Dr. Sanders , nor did they use the contralateral knee for graft.)
I know indivuals are different but I wonder if the skill,( e.g. maybe placement of graft,) doesn't have a bigger impact on outcome and/or pain then the studies suggest.
BTW: since I think skill is important wouldn't go to a surgeon who can't supply any patients for me to talk to-a doctor we visited recently acted surprised at this request and still can't provide any to talk to. (as many of you know Dr. Sanders has lots of patients willing to share their experience-I'm out of state but had one talk to me for about an hour.) I think that is a telling sign right there.
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