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Bob's ACL WWWBoard

Re: Level Of Evidence: Skill of Surgeon/Graft Type Ranking

Posted By: OLarryR
Date: Wednesday, 13 January 2010, at 6:38 p.m.

In Response To: Level Of Evidence: Skill of Surgeon/Graft Type Ranking (TC)

Skill of surgeon vs graft type, prehap, rehab, physical therapist, age of patient, activity level of patient and previous injury...

All are important but age of the victim to me is of little imprtance compared to the other factors !

Skill of surgeon probably most important. But I have to tell you that after I was making great progress in recovery, my OS then confided to me that he had 3 reconstructions that day and i was first. he was sick as a dog that day. After that discussion, all I could think of (imagine) was him performing one of the operations and then letting go with a big sneeze as he was in the knee. Yuck !

The prehab is important but I would rate the rehab/PT/not getting ahead of the protocol (returning to activities before given the go-ahead by the OS) as more important for long term success.

Previous injury......taken to an exagerrated condition like a mangled leg...that then has to rate as very important. Previous injury is too hard to rate since it is too broad a factor without specifics. If one was missing a good deal of their cartilage and then suffered the current injury with a cartilage tear and a severed ACL, the outcome could be affected by the accumulation of significant lost cartilage especially if in load bearing areas and extensive - Could leave one with a successful reconstruction but with discomfort. In most instances, though, a past cartilage trim job and then again with current injury along with an ACL reconstruction will have a fine recovery. Separate issue is if the current injury was say longer than 8 months ago and now getting the ACL reconstructed...Sue used to publish that the reconstruction success rate drops off about 10% or more if not done in approximately the first 6 months since the injury.

Larry
http://www.olarryrknees.homestead.com/acl.html

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