BEAR ACL Surgery what are the pros and cons

[martyg]

It tough to beat the Steadman Clinic. Send films to them and set up a Zoom consult.

I assume that your two docs are local. Don’t limit yourself. Don’t rule out getting on a plane.

One of the things they did (may still do it), their director of regenerative medicine was involved with a lot of surgeries. They used PRP or stem cell at the time of surgery. Through this process he is building the data set for FDA approval of stem cell injections. They don’t just “fix”. They optimize. Their trade are athletes that are top of their game.

 

[dovski]

It tough to beat the Steadman Clinic. Send films to them and set up a Zoom consult.

I assume that your two docs are local. Don’t limit yourself. Don’t rule out getting on a plane.

One of the things they did (may still do it), their director of regenerative medicine was involved with a lot of surgeries. They used PRP or stem cell at the time of surgery. Through this process he is building the data set for FDA approval of stem cell injections. They don’t just “fix”. They optimize. Their trade are athletes that are top of their game.

Thanks @martyg, very familiar with the Steadman Clinic, believe it or not we actually have some bleeding edge sports medical research and practitioners here in Seattle

My daughter's care team includes a surgeon who works with several pro sports teams and pro athletes. We also have a PT clinic that works exclusively with elite athletes and more importantly and a supervising PT/sports rehab specialist out of Arizona who works with MLB. We also had consults with two other surgeons, one of whom specializes in the BEAR method.

The BEAR method uses PRP and stem cells, but so does our surgeon. What is really nice is that we already had relationships with this care team and were able to get surgery scheduled with them 2 weeks after the formal diagnosis. This is important as my daughter is heading off to college in Canada next year and we want the bulk of her rehab completed before then. That said we have lined up a sports medical and rehab clinic in Canada that works with the Canadian Olympic team, and they will take over her care and rehab in September when she moves to Canada for school.

FYI the Steadman Clinic is one of the early adopters of the BEAR method. Based on my current research and expert advice from several trusted practitioners this method still needs more data on its performance and failure rate over time with adults which is why we decided to go with a traditional ACL replacement. My understanding is that no pro/elite athletes have had the BEAR method yet so we also do not have any data on how this approach stands for a high performing athlete.

 

[martyg]

C

Thanks @martyg, very familiar with the Steadman Clinic, believe it or not we actually have some bleeding edge sports medical research and practitioners here in Seattle

My daughter's care team includes a surgeon who works with several pro sports teams and pro athletes. We also have a PT clinic that works exclusively with elite athletes and more importantly and a supervising PT/sports rehab specialist out of Arizona who works with MLB. We also had consults with two other surgeons, one of whom specializes in the BEAR method.

The BEAR method uses PRP and stem cells, but so does our surgeon. What is really nice is that we already had relationships with this care team and were able to get surgery scheduled with them 2 weeks after the formal diagnosis. This is important as my daughter is heading off to college in Canada next year and we want the bulk of her rehab completed before then. That said we have lined up a sports medical and rehab clinic in Canada that works with the Canadian Olympic team, and they will take over her care and rehab in September when she moves to Canada for school.

FYI the Steadman Clinic is one of the early adopters of the BEAR method. Based on my current research and expert advice from several trusted practitioners this method still needs more data on its performance and failure rate over time with adults which is why we decided to go with a traditional ACL replacement. My understanding is that no pro/elite athletes have had the BEAR method yet so we also do not have any data on how this approach stands for a high performing athlete.

Cool. Very familiar with that scene. We lived in Gig Harbor, had our ski house(s) in Glacier, and taught at Baker.

Look up Anne Healzer, PT. She has her fellowship and is a PSIA L3. She used to be with MTI PT out of Issaquah. She provides a great, performance based approach, especially for skiers.

 

[dovski]

C

Cool. Very familiar with that scene. We lived in Gig Harbor, had our ski house(s) in Glacier, and taught at Baker.

Look up Anne Healzer, PT. She has her fellowship and is a PSIA L3. She used to be with MTI PT out of Issaquah. She provides a great, performance based approach, especially for skiers.

You actually connected me with Anne last year and my daughter wne to MTI in Issaquah
Anne no longer works on the Eastside and the PT we really love (who works with MLB during Spring training) moved to Arizona, so we are going to have him help structure and monitor her rehab via tele health and a PT office he works with in Redmond will be our day to day. The actual PTs who will be working with my daughter are both athletes which really does make a difference in IMHO. We are thinking of doing the summer ski rehab clinic that I believe Anne is involved with in addition to the regular PT, but we have to figure our dates first.

 

[martyg]

You actually connected me with Anne last year and my daughter wne to MTI in Issaquah
Anne no longer works on the Eastside and the PT we really love (who works with MLB during Spring training) moved to Arizona, so we are going to have him help structure and monitor her rehab via tele health and a PT office he works with in Redmond will be our day to day. The actual PTs who will be working with my daughter are both athletes which really does make a difference in IMHO. We are thinking of doing the summer ski rehab clinic that I believe Anne is involved with in addition to the regular PT, but we have to figure our dates first.

Nice! I nee to contact Anne about that summer clinic. Sounds interesting. Enjoy!

 

[dovski]

Nice! I nee to contact Anne about that summer clinic. Sounds interesting. Enjoy!

Yeah our surgeon was the one who recommended it as a way of accelerating the rehab, so we are still waiting on details. Surgery is not till Friday and we have already booked 3 months of PT visits

 

[robertc3]

It sounds like you have everything mapped out and your daughter will be back on skis in no time. Sorry we didn't get to chat more at White Pass. Your son made a big jump from Saturday to Sunday. He should be quite proud of that. Nice work, coach.

 

[Jwrags]

I am glad you got the information you needed to make an informed decision as well as a surgeon you are comfortable with. Best of luck with your daughter’s surgery!

 

[dovski]

It sounds like you have everything mapped out and your daughter will be back on skis in no time. Sorry we didn't get to chat more at White Pass. Your son made a big jump from Saturday to Sunday. He should be quite proud of that. Nice work, coach.

Thanks Robert,

Unfortunately this is not the first time we have had to deal with a torn ACL so as the saying goes practice makes perfect .... though if you can avoid it all together I highly recommend it. Luckily this is an injury that you can fully recover from and actually come back even stronger ... so the goal now is surgery followed by lots of PT.

White Pass was a fun time, and my son had his best results of the season. If only his day one run was on par with his day two he could have cracked the top ten ... either way he was super stoked and wants to spend the summer in South America so he can double down on his training lol.

Looks like your son had a great year with a couple podiums. Hopefully we can follow his example next year and climb up the rankings

 

[Pequenita]

Best wishes to your daughter for a boring procedure and rehab.

 

[Eric@ict]

My wife tore her ACL, MCL, and Meniscus. Her surgeon (Vail Ortho), told her surgery wasn’t needed, if she didn’t want to ski. That wasn’t an option. ACL came from a Cadaver, MCL came from quad ligament and a couple of stitches for the meniscus. He said they no longer use the hamstring due to the increased recovery time. Surgery was last year and she is skiing this year. She has talked to people who had the same surgery but used the hamstring and they have said the recover was over a year.

 

[mdf]

I had hamstring and recovery was less considerably less than a year. Surgeon said wait a year to ski but I cheated by a month and a half.

My usul advice: do the method your surgeon thinks is best, and if you don't agree, get a different surgeon. (I don't want my surgeon going in with negative thoughts, and doing a method they have less experience with.)

 

[dovski]

So currently the favored methods are to use your hamstring or quad to replace the ACL, though they still use patella for contact sports. Cadaver is favored for those whose own tissue is not good enough or who are a little older as it does not require the harvesting, healing and rehab of other areas. Our surgeon broke it down like this:

• He prefers hamstring for skiers so you don't weaken the quad or compromise the patella
• Quad for running sports so you don't weaken the hamstring
• Patella for contact sports like football just because that is what they have always done and it seems to work
• Cadaver for the elderly infirm as it is an easier recovery and typically the ACL replacement does not need to last as long or get used as vigorously
• Hybrid (cadaver plus your own tissue) is used when what they harvest is not enough for some reason

Now this is just our or surgeon approaches things and he specializes in working with elite athletes. He claims that he use data to determine which procedure will last the longest and have the lowest failure rate. He also looks at which procedure will help athletes get back to 100% performance as quickly as possible. Regardless of the procedure he says it takes the human body 6 months to heal all the tissues correctly and for most people at least 8-9 months of rehab to get back to 100% and be cleared to return to sports. When my wife had her ACL done she doubled down on rehab and was at the PT office 4-5 times a week for 5 months after which she got the all clear but still had to wait a month before the doctor cleared her for skiing.

Cannot stress that the rehab post surgery is absolutely crucial and finding the right PT is just as important as finding the right surgeon, so do your homework. My other recommendation is that if you do not have pre-existing relationships with a care team you trust get a couple different opinions as things are always changing. In our case we had the care team in place and still did our research and got to additional consults just to be safe. The last thing I will recommend is that you be proactive by:

1. Always seeing a specialist as opposed to GP if you think you have an injury like this
2. Push for the MRI quickly as opposed to waiting
3. Start PT immediately as the pre-surgical PT is hugely important
4. Get your surgery booked ASAP as the good docs can book out
5. Book all your PT appointments for post surgery upfront as PTs also get booked out and you want to ensure there is no interruption in rehab

Again this is just my personal opinion and it is absolutely driven by the advice and guidance I am getting from my trusted care team.

 

[Jwrags]

Don’t forget to take your care team yummy treats so they are excited to see you on the schedule

 

[robertc3]

So currently the favored methods are to use your hamstring or quad to replace the ACL, though they still use patella for contact sports. Cadaver is favored for those whose own tissue is not good enough or who are a little older as it does not require the harvesting, healing and rehab of other areas. Our surgeon broke it down like this:

• He prefers hamstring for skiers so you don't weaken the quad or compromise the patella
• Quad for running sports so you don't weaken the hamstring
• Patella for contact sports like football just because that is what they have always done and it seems to work
• Cadaver for the elderly infirm as it is an easier recovery and typically the ACL replacement does not need to last as long or get used as vigorously
• Hybrid (cadaver plus your own tissue) is used when what they harvest is not enough for some reason

Now this is just our or surgeon approaches things and he specializes in working with elite athletes. He claims that he use data to determine which procedure will last the longest and have the lowest failure rate. He also looks at which procedure will help athletes get back to 100% performance as quickly as possible. Regardless of the procedure he says it takes the human body 6 months to heal all the tissues correctly and for most people at least 8-9 months of rehab to get back to 100% and be cleared to return to sports. When my wife had her ACL done she doubled down on rehab and was at the PT office 4-5 times a week for 5 months after which she got the all clear but still had to wait a month before the doctor cleared her for skiing.

Cannot stress that the rehab post surgery is absolutely crucial and finding the right PT is just as important as finding the right surgeon, so do your homework. My other recommendation is that if you do not have pre-existing relationships with a care team you trust get a couple different opinions as things are always changing. In our case we had the care team in place and still did our research and got to additional consults just to be safe. The last thing I will recommend is that you be proactive by:

1. Always seeing a specialist as opposed to GP if you think you have an injury like this
2. Push for the MRI quickly as opposed to waiting
3. Start PT immediately as the pre-surgical PT is hugely important
4. Get your surgery booked ASAP as the good docs can book out
5. Book all your PT appointments for post surgery upfront as PTs also get booked out and you want to ensure there is no interruption in rehab

Again this is just my personal opinion and it is absolutely driven by the advice and guidance I am getting from my trusted care team.

You have this down. Other people looking for ACL information would do well to read this thread. Lots of great information. Your daughter is in good hands and will be back to her old self in no time.

White Pass was a fun time, and my son had his best results of the season. If only his day one run was on par with his day two he could have cracked the top ten ... either way he was super stoked and wants to spend the summer in South America so he can double down on his training lol.

Looks like your son had a great year with a couple podiums. Hopefully we can follow his example next year and climb up the rankings

If your son's plan for a South American summer trip doesn't pan out, Party Beach at Mt. Hood is a good second option. Caedan will be there for his third time this summer and he loves it. They build a really great community at that camp. Caedan was at Panorama BC this fall when one of the coaches was there and they met up and chatted a couple of times. In January we were down at Palisades and one of the other coaches recognized my son in the lodge and came over to talk. It was really cool. The coaches have an extensive racing background, so they teach ski technique as well as freeride and jump skis. The more time your son is on the snow the better, no matter what hemisphere it is in. PM me if you want more info on Party Beach.

Caedan's season was up and down. Some great skiing and some crashes. He won the sick bird/flying squirrel award twice which is two too many. Nice that the judges saw skiing they likes, painful that he had issues on what would have been great runs. He takes those so hard. It is actually why we were at White Pass, to get him a low pressure comp where he could build some confidence, have fun, ski with some friends. At least the skiing with friends happened. His racing season went quite well, so he was happy over all. Two more weekends of racing next month.

 

[surfsnowgirl]

My wife tore her ACL, MCL, and Meniscus. Her surgeon (Vail Ortho), told her surgery wasn’t needed, if she didn’t want to ski. That wasn’t an option. ACL came from a Cadaver, MCL came from quad ligament and a couple of stitches for the meniscus. He said they no longer use the hamstring due to the increased recovery time. Surgery was last year and she is skiing this year. She has talked to people who had the same surgery but used the hamstring and they have said the recover was over a year.

Similary to my guy who tore his ACL and Meniscus. His orthpedic surgeon wasn't a fan of "quick" methods/recoveries and said there's a reason most atheletes follow the 9 month surgery/rehab plan. Michaels doctor works with the local school ski team and skis himself. He tore his own ACL a few years ago. He recomended the alagraph from the cadaver and Michael now has the knee of a teenager. He was skiing 9 months post surgery/rehab. Other people who didn't do the cadaver part have had a much longer rehab. Including our friends daughter who tore her ACL at 16. Due to her age it wasn't recommended to do the cadaver part and she is skiing again but her rehab was a bit longer and he knee still bothers her at times, she's fine now but for a couple seasons she didn't get back to where she was pre injury.

Glad your wife had a very successful recovery, etc.

 

[dovski]

Similary to my guy who tore his ACL and Meniscus. His orthpedic surgeon wasn't a fan of "quick" methods/recoveries and said there's a reason most atheletes follow the 9 month surgery/rehab plan. Michaels doctor works with the local school ski team and skis himself. He tore his own ACL a few years ago. He recomended the alagraph from the cadaver and Michael now has the knee of a teenager. He was skiing 9 months post surgery/rehab. Other people who didn't do the cadaver part have had a much longer rehab. Including our friends daughter who tore her ACL at 16. Due to her age it wasn't recommended to do the cadaver part and she is skiing again but her rehab was a bit longer and he knee still bothers her at times, she's fine now but for a couple seasons she didn't get back to where she was pre injury.

Glad your wife had a very successful recovery, etc.

I think there are so many factors that go into a good recovery that there is no one right approach to this, it is very much dependent on the patient. Our surgeon uses data around failure rates over time to drive a lot of his decisions, so while harvesting a hamstring or quad will create a slightly more complicated recovery than cadaver, he believes that the long term failure rate for a high performing athlete is much lower. We trust his judgement on this, but we also know that there are many different opinions. In my wife's case her recovery took about 5 months though she still waited 9 before returning to skiing and her knee is better than it was before the injury.

The BEAR method claims a return to sports after 4 months but has a 12 month rehab protocol and little to know long term data on failure rates in adults. This could be the future of ACL surgery, but given the lack of data there are a lot of unanswered questions, so we opted to go with something tried and true vs an experimental method.

Bottom line is that you need to do your research to find the right care team for you and then trust the decisions they make which will be unique to you and your specific situation.

 

[surfsnowgirl]

I think there are so many factors that go into a good recovery that there is no one right approach to this, it is very much dependent on the patient. Our surgeon uses data around failure rates over time to drive a lot of his decisions, so while harvesting a hamstring or quad will create a slightly more complicated recovery than cadaver, he believes that the long term failure rate for a high performing athlete is much lower. We trust his judgement on this, but we also know that there are many different opinions. In my wife's case her recovery took about 5 months though she still waited 9 before returning to skiing and her knee is better than it was before the injury.

The BEAR method claims a return to sports after 4 months but has a 12 month rehab protocol and little to know long term data on failure rates in adults. This could be the future of ACL surgery, but given the lack of data there are a lot of unanswered questions, so we opted to go with something tried and true vs an experimental method.

Bottom line is that you need to do your research to find the right care team for you and then trust the decisions they make which will be unique to you and your specific situation.

Yup indeed. Could be the future is the operative word but as you said time will tell and everyone needs to do their own research. I'm always suspicious of "quickee" fixes. Definitely important to trust yourself, your research and most importantly your doctor and care team.

We went with what our orthopedic sports doctor advised, what's worked for most people including most athletes and what we know people have done in the past that didn't work. We know many people who didn't follow this method or deviated from it and they've had nothing but issues.

A friend's wife tore her ACL and opted against surgery, walks with a cane, lives in constant fear of hurting herself and has never skied since. To each their own. It's all about research and personal choices.

Ski on.

 

[DanaMcc]

I chose the BEAR procedure and had my surgery on April 15 at Evergreen! I’m an expert skier (except for that one fall! ).
I hyperextended my knee skiing the bumps and ruptured my ACL. I’m 66 and was faced with 3 options. No surgery (I had good function) and “modify my activities”, ACLR with allograft, or BEAR. Despite the lack of long term data, the procedure made sense to me. I plan to be skiing again next season. Best wishes for an excellent recovery!

 

[dovski]

I chose the BEAR procedure and had my surgery on April 15 at Evergreen! I’m an expert skier (except for that one fall! ).
I hyperextended my knee skiing the bumps and ruptured my ACL. I’m 66 and was faced with 3 options. No surgery (I had good function) and “modify my activities”, ACLR with allograft, or BEAR. Despite the lack of long term data, the procedure made sense to me. I plan to be skiing again next season. Best wishes for an excellent recovery!

@DanaMcc Super interested to hear about your experience and recovery, and hope everything is going well. They actually offered us the April 16th surgery date upfront.
We are almost a month out from my daughters surgery and this will be her last week with a brace. Somehow she tore her ACL in a non traumatic way and continued to do everything normally for a month afterwards. Our surgeon explained that about 10% of the population can function normally without an ACL which is wild. So far her recovery is actually ahead of schedule as she was able to fully extend her leg and fire her quads at her first post opp visit, this meant she could ditch the crutches start more aggressive PT exercises much earlier. Super important as she graduates high school this year and has some travel planned plus is heading off to college in August. Having her fully recovered before that is our goal.

Hopefully with the BEAR procedure you have the accelerated recovery and return to sports they thought ... again very interested to hear how this goes and the BEAR approach may be the future of ACL surgeries.