ACL Surgery Demystified
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| Mark Schroeder |
Biking, skiing, snowboarding, and trail running can all end disastrously with a hyperextended or twisted knee. Stretch your delicate anterior cruciate ligament beyond its tensile strength and a distinct champagne-bottle pop will likely follow. Not good; it's the auditory calling card of a torn ACL. "With a small tear, if there is no looseness in the
joint, you could just do rehabilitation," says Richard Steadman, Picabo Street's orthopedic surgeon, who may have just saved you $20,000 in surgical costs. "But a full tear that weakens the joint will require a full reconstruction."
If you're in for the latter, there are two ways to go. World-class athletes almost universally prefer Steadman's method of using strands from the patellar tendon (see knee diagram, above), rather than the more common approach of grafting the hamstring tendons, to build a new ACL. "We did a study that found the [hamstring] is used throughout the ski
turn," Steadman says. "You may lose something at the highest competitive level if you use that tendon."
The downside is that rehabilitation for a patellar graft can keep you off your feet longer and in a lot more pain than a hamstring graft, and it has the potential to cause tendinitis down the road. For the recreational athlete, stealing from your hamstring is the ticket, according to John Garrett, former chief resident of orthopedics at Harvard and
founder of Atlanta-based Resurgens, which treats NFL players. "If you're aggressive, you can be off crutches in four to five days, on a bicycle by the end of a week, and back in your office," he says. "A patellar graft can keep you on crutches for up to six weeks." The success rates for both procedures hover in the 90-percent range. Either way, pick an
orthopedic surgeon who subspecializes in knee operations and has a high-volume practice. And keep in mind that surgery is just the first step to becoming the badass you once were. "You have to go into it with the idea that more than half the job is yours," says Steadman. "The surgery is two hours, but the recovery is six months." —C.K.
Headstrong to Headlong
You've rebuilt your broken body; now heal the mental damage and come back stronger than ever
The trauma of surgery and the pain of physical therapy can seem insignificant compared with the psychological roller-coaster of getting back into your sport. Or, as U.S. Ski Team Coach Jim Tracy so delicately puts it: "You'll have a lot more shitty days than good days." The first time back on a bike, skis, or snowboard will be frustrating, and
maybe even traumatic. You'll lack fluidity, timing, and, worst of all, the confidence to talk smack to your opponents. Here are the psychological steps to rebuilding your inner superstar.
1. Erase all doubts. "Every time [Picabo] comes in here," says orthopedic surgeon Richard Steadman, "she just will not accept the fact that she's not going to come back. With her it's always been 'when I come back,' not 'whether.'" Indeed, 90 percent of athletes who commit to their rehab protocol return to sports
following ACL surgery, and many return stronger.
2. Involve yourself. "For an athlete, nothing rebuilds peace of mind like committing to the rehab protocol to the nth degree," says Damon Burton, a Sports Psychologist from the University of Idaho who has consulted with the U.S. Ski Team. Like Street, he recommends knowing every detail of your physical therapy so
that when you're back at your sport again you'll know that you have cleared every physical hurdle and your focus can be on technique rather than worrying about what your body can handle.
3. Rebuild incrementally. "It's a progression," says ski coach Jim Tracy. "We don't throw Street right into another downhill." Build a foundation of ego-boosting successes by spending your first weeks back in the sport remastering the absolute basics.
4. Know when to drop the hammer. After three career-threatening crashes, Street knows when to say when. If you're not comfortable with a certain speed or technique, don't force it. "You've got to be able to categorize the task at hand, determine if you can overcome the fear," Street says. "And if you can't, walk
away. Because if you don't, the fear will inhibit your chance of succeeding."
5. Find a mentor. Because U.S. Ski Team members are plagued by knee injuries, they have dozens of successful cases to call upon for inspiration. When you return to your sport, try to work out with someone who has come back from the same injury. He can help you decide when it's okay to push, and when to hold
back.
6. Visualize success. After her crash, Street was tormented by nightmares. "I dreamt I'd have to stop mid-race when I hit the fast sections," she says. To overcome her subconscious fears, Street imagines herself skiing entire downhill runs in rough conditions so that even in her dreams she is winning races.
Mentally rehearse the most difficult aspects of what you'll be doing, and picture yourself succeeding each time. —C.K.
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