Exclusive Interview with Dr. Tom Myers: ACL Reconstruction
Why Surgeons as a whole are performing only a B+ ACL reconstruction and what the consequences are
Graft Failure is more common than Reported
Here’s the issue; over 100,000 ACL reconstructions are performed in the U.S. alone every single year but these reconstructive surgeries have only really been implemented since the 1970s. With only 40-50 years of long term outcome studies and the rise in female participation in sports sprouting in the 1990s causing thousands of ACL injuries for people under 25 years old; we really are not proficient enough in providing a long term solution to these athletes who have torn their ACL.
ACL reconstructions have become very common and because of the contact nature in men’s sports and the increased risk of ACL injury in female sports we are seeing more ACL injuries than ever before. Unfortunately the bad news is that the long term repercussions of this procedure are slowly surfacing as the athletes from the 70s and 80s are aging and seeing long term arthritis problems and as the athletes from the 90s are entering their 20s and 30s the amount of cases with graft failure, arthritis, and meniscus tears down the road are steadily increasing.
What’s worse is many surgeons have different preferred techniques for ACL reconstruction and because they don’t keep track of their long term outcome studies appropriately or their patients with complications go see other surgeons; many surgeons don’t realize that many of the long term outcomes of their reconstructions are poor. This can include anything from a re-injury to arthritis, joint laxity, meniscus tears, and even failure of the graft.
Different Techniques for each Surgeon...?
All of these issues are very significant to my life as I’ve had 4 ACL revision surgeries off of only 2 initial ACL injuries. In December I will have had a total of 8 surgeries and I am not even 30 years old yet. I have not played sports or even gone running since I was 14 years old; I never had a re-injury…the previous surgeons simply drilled my tunnels at the wrong angle which caused my graft to stretch out over time. Many of the athletes that I have met over the years have encountered similar problems with their ACL journeys so I knew that there had to be a better way to approach these injuries and surgeries and that a major change needs to be made in the industry in order to prevent other athletes from suffering the same fate as me.
Dr. Tom Myers in Atlanta, GA saw these same flaws with the procedures when he was doing his sports medicine fellowship and in 2003 he came up with his own version of the ACL reconstruction because with all of his research he found major technique problems in the current surgery methods and wanted to design something with a better long term outcome for his patients.
The problem is many people who tear their ACL find a surgeon that is in their insurance network and without doing research or interviewing the surgeon just trust that he or she will give them an A+ surgery.
“They think this is a surgeon and he or she went to medical school and has training and has great knowledge of the operations and I’m sure 100% of his or her patients get back to playing sports. I’m sure that 100% of his or her patients rehab in six months and I’m sure that there is no chance for re-tear or re-injury. The idea that it’s actually not 100% is sometimes surprising to people. And it’s not something that orthopaedic surgeons will talk about when they are first meeting somebody and signing them up for surgery.”Dr. Tom Myers
Make sure that you do research on your surgeon before you are so trusting. Dr Myers lists a few tips to search for and ask your surgeon before deciding on doing an actual procedure.
“One of the problems that we have is that the average surgeon that does these reconstructions does about 10 a year. It has a lot to do with the demographics of how the orthopaedic surgeons are spread out throughout the nation. It has to do with the fact that there are a lot more rural doctors that are just general orthopaedic surgeons and that the ACL is treated as a common orthopaedic injury that most doctors can handle. It’s been show in the total joint literature and other realms of orthopaedics that we need to do somewhere between 30 and 50 cases a year to become a specialist or an expert or have your skillset even be reasonable. So doing 10 a year you’re not really improving your skillset and if that’s the average number of cases that the orthopedic surgeons are doing then were probably not getting A+ ACLs. The biggest and most important factor in whether or not you get an adequate ACL reconstruction has to do with the experience of the surgeon. There’s a sports medicine specialty, an extra year of training that doctors go through after they become an orthopedic surgeon where they can spend a year treating sports injuries. A lot of focus of that year of training is on ACL.”Dr. Tom Myers
Make sure you ask your surgeon the following:
- How many of these cases they do per year?
- Are they sports medicine trained?
- Did they do a fellowship where they learned how to do this operation?
- Do they have any long term outcome studies on their ACL reconstruction?
- How do they drill the tunnel? Anatomically or just the way they prefer to drill?
It is important to know that the surgeon you select for your surgery has a humongous impact on the long term longevity of your knee. Many athletes do not return to the same level of play as before the surgery and this all has to do with the way your surgeon performs your operation. Many people believe ACL surgeries are common and easy to comeback and return to sport because of some of the famous athletes’ comebacks but this is not always the case. Even so, many of these famous athletes are able to play a few more years in their sport but 10 years down the road have many complications due to the nature of their surgery and how it was executed. This is never reported in the media. Again we are just now learning and studying the learn term effects because this is a relatively new procedure.
“The numbers don’t really suggest that this is a great operation. If were suggesting that patient expectations are that they will get back to playing college football, high school football, or recreational soccer and 1/3 of those patients aren’t ever getting back; that’s not an operation that we are particularly proud of. What that means is that if I’m sitting here telling you were doing a B+ ACL, our failure rates are anywhere from 4% of the graft re-rupturing to 36% that you’ll never get back to playing your sport at the same level that you were before somewhere in there is probably a number that suggests what the true failure rate is and it’s very high. That means that we should A) figure out why they are failing and B) do a better job of fixing them. “Dr. Tom Myers