by Mitch Hauschildt, MA, ATC, CSCS
In my younger, more arrogant years, I used to think that a surgery was a surgery and I could rehab any surgeon’s work and get people back to a high level of activity, regardless of the structural repair. Over the years, I have learned that this process takes great teamwork between surgeons and clinicians. With my role in college athletics, I see a lot of ACL reconstructions, shoulder labral repairs, and a host of other surgeries sprinkled in, so most of my experience is in those areas.
A few years after I began practicing consistently in a rehab setting, I had a young lady who was struggling to recover from her ACL surgery. After seeing another surgeon, it was determined that the reason that she wasn’t getting better was because of poor surgical placement of the graft. Unfortunately for her, the graft was placed in a position that was too vertical. It was an eye opening experience for me as a young athletic trainer because it became clear to me that no matter what I did or how good I was for her, I would never be able to fix her knee because her underlying reconstruction was faulty.
Since that time, I have worked with a number of athletes from surgeons from around the country. Some of them have done great and others, unfortunately, have had some pretty significant issues. In recent years, I have also learned of the American Journal of Sports Medicine stat that states that of the 175,000 ACL surgeries performed each year, 85% of them are performed by surgeons who perform less than 10 per year. That’s a scary stat to me. That might just explain some of the issues that we are seeing with our kids from outside of our system (although that doesn’t explain them all because many of the revisions that we have performed have been done by surgeons who routinely work with professional teams).
I know that there are great surgeons who do a good job, even though they don’t perform an ACL reconstruction every day (or month for that matter), but I think it is also common sense that if someone performs a lot of a particular procedure, that they are much more likely to refine those skills and have better outcomes. I personally want the surgeon who does 10 of my surgeries per week operating on me.
I have also found over the years that different surgeons are harder on patients in surgery than others. I’m not exactly sure what happens in there and what defines one versus the other with regards to their technique (because I’m not a surgeon), but what I know is that some patients come out with very little swelling or bruising while other surgeon’s cases tend to be very bruised, effused and have a lot of pain following their procedure. I feel that the first couple of weeks following a surgery are very important, so when I see people who appear to have a lot of trauma in surgery, it definitely sets their time frame back a while.
Because of these concerns, I have become very preferential with the surgeons that I work with. I’m lucky in my job that if our athletes have surgery while with us, it is only performed by a small group of physicians that we know well and trust. Not everyone has that luxury and many people reading this post end up taking what is referred to them. And, I am not always that lucky either because many of our athletes have had surgery prior to coming to our university or while at home over a break. We end up revising those procedures a lot more often that I would like.
I encourage everyone reading this post to create a close alliance with their surgeons, physician assistants, and other healthcare providers. When my surgeons know that I trust them and send them patients, they are more willing to work with me when I need help. Identify the physicians that are doing a great job and send them your patients. Make friends. Get on the same team. Communicate and show them that you care. If they want to learn what you do, teach them. Ask them questions about their procedures and what they found during a case. It will make your life easier.
The surgery is just as important as the therapy. The therapy is just as important as the surgery. You MUST have both to have a great outcome. Recognize that and do anything you can to work with people who recognize that. You will make magic happen.
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