Bob's ACL WWWBoard
Posted By: D. Hall
Date: Saturday, 14 January 2006, at 4:46 p.m.

ACL Revision Surgery at the Sanders Clinic, Houston

My daughter Angie, an 18-year-old gymnast, had ACL revision surgery at the Sanders Clinic (Dr. Mark), on January 6, 2005. I am posting our experience mainly for those who have been visiting this board over the last few months who have been either skeptical of, or interested in, Dr. Sanders' methods. Please don't hesitate to email me if you'd like more info. This was Angie's third major surgery after countless injuries over the last 6 years. We chose Dr. Sanders mainly because we were convinced the Patellar tendon would be the best graft source, and the Patellar in her ACL leg has already been harvested. He uses the outer-third section of the tendon in the opposite leg - something we hadn't heard from any other doctor. I believed taking some of the burden from the ACL leg and rehabbing them both together made a lot of sense, so we made plans to travel from Philadelphia to Houston to see Dr. Sanders.

We arrived last Thursday for consultation. He had reviewed her x-rays and explained to us that the main reason the first graft failed was that the tunnel was too anterior (too far to the front of the knee). He talked about his procedure, why he did things the way he did, and what to expect after surgery, in addition to the rehab process. He spent a considerable amount of time with us - probably because he could feel Angie was worried about our decision to travel for surgery, and that she was skeptical of his "un-doctor-like" personality. A little rough around the edges, his direct, open, tell-it-like-it-is approach caught her off guard. (By the end of our 2d day there, she decided this rare trait in a doctor was actually a quality):)

Surgery was the following morning. In recovery, she was set up with a CPM machine, an electric shuttle that automatically flexed and extended her ACL leg. When she arrived in her hospital room later that morning, she was on the CPM, and had a Cryo-Cuff on each knee, and drains in both knees. The CPM was set at 30 degrees flexion to -5 extension, with instructions to change the flexion to stop at 110 degrees flexion for 10 minutes of each hour. We had some frustration with this, as the hospital staff was not familiar with the machine and there was confusion over how to use it. Discussions with the CPM rep, doc, and therapist over the next few hours got us on track. Dr. Sanders visited around 5 p.m. and took Angie for a walk. She made two laps around the hospital (about 1500 feet). Trust me, this was not a piece of cake, but the more she walked, the easier it seemed to get. She did this unaided, without crutches, dragging her IV pole along with her. Later in the evening, Ed, the therapist, came and spent about 1-1/2 hours with her. She did a variety of exercises (leg lifts, curls, extensions, shuttle on opposite leg, etc) and took another short walk, but nausea kept her from walking very far. He set the CPM at 50 degrees flexion to -5, with instructions to let it run like that all night.

Dr. Sanders came back in the morning, took her through an exercise session/walk, and he removed the drains. Ed visited again that afternoon for more exercise/talk, and gave us instructions for what we would be doing in the hotel room over the next few days. Mainly, one hour of exercising 3X/day – bed rest the remaining time, and only walking to and from the bathroom (for the remaining part of Sat, Sun, & Mon). We took the CPM, Cryo-Cuffs (which remained on her knees all of the time instead of during flexion exercises), and the manual shuttle to our hotel room. She was taking Darvocet for pain (or Tylenol), Toradol (followed by Ibuprofen), and injections of Lovenox to help prevent clotting. Her exercise sessions were painful, but not unbearable. She pretty much had full extension and good flexion, and by the time she finished her first therapy session with Ed in the office on Tuesday, she had hyperextension back in both knees and flexion to 145 degrees. She started her therapy session on Tuesday with a 30-minute ride on the stationery bike at over 80 rpms. On Wednesday we returned the equipment (except the Cryo-Cuffs) to Dr.'s office and had another therapy session/instructions. At this point Angie was doing step-ups and squats in addition to the bike ride, flexion/extension exercises, etc. We said good-bye to Doctor Sanders and staff and went back to the hotel for our last day of hotel-room therapy. They made sure we had cell numbers and email addresses so we can remain in regular contact (and throughout our stay they made themselves available via cell as well - our first experience with having a doctor answer our calls like that!). I'll report her progress to them, and we have exercise/care instructions to follow.

Our trip home on Thursday was pretty rough - packed, delayed flights and way too much stress, but Angie has recovered at this point and is doing great on second day home. She walks pretty much normally. One week after ACL revision surgery, she rode the bike for 45 minutes today, exercised, and has gone to a friend's house to watch the Redskins game. It was difficult being away from home, but we think we made a good decision, and hopefully this will be a more positive recovery than the ones she's experienced in the past! She didn't miss the post-op brace and crutches, for sure, and she's glad to be going up and down the stairs, slowly, but in a normal fashion!

Anyway, good luck to everyone. Just email us if you'd like to know more about her progress, and I'll post any setbacks. Supposedly after the first month she'll be able to take the first major step (running) if things go well, so I'll let you all know how that goes. As for Dr. Mark Sanders and the skeptics out there - we heard countless comments from nurses, patients in his waiting room, and other healthcare workers that reinforced our decision. He is a skilled surgeon who wants only the best life has to offer for his patients, and I think we will always be thankful we found him. He also has a great staff - our therapist, Ed, is the best we've ever worked with. He's given us so much of his time and advice on all aspects of recovery - from nutrition to overall body conditioning. They are a great team!

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