Timing for an ACL surgery- Is it a good idea to have surgery 3 months before your wedding?

Posted on June 12, 2013

3


A question from Will; a question more people should ask themselves!

Dear Brian,

Hi! I would just like to say first of all that I have really enjoyed all of the information you have put together on your website. You write really well, the articles are informative and entertaining, and the material is clearly well researched.

About myself – I am a 26 yr old who tore the ACL of my left knee playing basketball this past February. In addition, there is a meniscus tear, apparently a complex type. I’ve had the MRI’s, seen several surgeons, and have currently undergone over 3 months of PT. At this point, my knee has returned to near normal strength, and I am already completing jumping exercises with the help of a brace. I have been hoping to use the PT to avoid the need for surgery, but both because of my competitive drive and nature of the injury, it seems surgery may be the ultimate path. I am not a professional player by any means, but I am afraid to lose my ability to play physical sports that require cutting and pivoting. Furthermore, although the PT has helped my strength, I still have mild occurrences of instability and pain nearly every day, which with the blessing of the doctors seems to indicate that the surgery might be necessary to correct all of the issues with the knee.

My main concern, however, is whether or not surgery will be too complicated of an issue to deal with at this point in my life. In all honesty, I really would like it done sooner rather than later so I can begin focusing on recovery, especially because even with the brace, it seems like pivoting will still be enough of a problem to not allow my favorite sports. The biggest issue… my wedding. At this date its about 3.5 months away. I realize I could be up and walking soon enough, but I’m guessing just being comfortable and considering dancing and whatnot may be a whole other beast. Ultimately my questions surround whether or not considering surgery before such an event would be on the absurd, risky, or somewhat reasonable scale. I realize the amount of work that must be done to regain the strength and stability to be active is immense, but I am curious about your opinion on whether or not you would consider such a surgery for a similar situation knowing what you have been through. The doctors don’t seem to have a problem with a 3 month recovery time frame, but I just don’t want to feel end up feeling stranded and unable to enjoy a day that is meant to be exciting and fun.

Thanks and I appreciate any advice you might have about this situation.

Hey Will,

Nice to meet you. Thanks for the kind words.

This is a great question. There are a bunch of factors to consider here. I’m going to rattle them off as they come to me.

Your graft choice

Part of this question will depend on what type of graft you get. A patellar graft is pretty well set at about 8 weeks post op; a hamstring graft at 10-12 weeks. Because I got a hamstring graft (I write extensively why here if you haven’t read that yet), I wasn’t comfortable with being out in say, a bar setting til that 12 week mark. I was terrified I would be out in a public place, someone would accidentally bump into me, and I’d screw up the graft. 3 months post op is right about when you’d likely feel pretty comfortable in a “dynamic” setting. If you got a patellar graft, perhaps a bit sooner.

And for a cadaver graft? At your age you shouldn’t be considering one.

What’s your wedding day like?

This may sound silly, but this also depends on the type of dancing you want to do at this wedding. If you’re looking to be jumping around, really getting into it, this is going to be hard 3 months post op. If nothing else, on a day where you really want to enjoy yourself, you WILL be thinking about your knee.

For instance, are you trying to get down like this?

However, if you’re having instability right now, you’ll be thinking about your knee regardless. And 3 months post op you’ll probably feel more stable than you do now, but you’ll also have more restrictions e.g. how many degrees you can bend your knee.

Really, either way you shouldn’t be doing anything too intense at the wedding. (Sorry, it’s the truth.) So I’m not sure this is where you want to base your decision.

Your significant other

If you want to do this right, and if you’re going to do it you might as well do it right, you’re looking at 6 months of very dedicated rehab. By very dedicated I mean 6 months, everyday. No, this doesn’t mean 8 hours a day, but you should be doing at least something everyday. And 6 months is really the minimum.

Going with that, each month is more intensive than the next. (Month 1 more than 2, 2 more than 3, etc.) If I were you, I’d be thinking “Do I really want to / Can I really dedicate myself this much -almost to where I’m taking on a part-time job- to rehabbing my leg while I’m getting ready for a wedding?”

For instance, “Is my fiance prepared to take care of me for two weeks while she is planning a wedding?” Take care of you means pretty much be by your side for two weeks. But maybe she can do this by your side while on her computer? My dad was able to work remotely, so despite being right next to me for two weeks, he still got a lot things done. Or perhaps she won’t be, or doesn’t need to be, the primary one taking care of you. And maybe you’re not that involved in the wedding if your only job is to show up. (Rattling off hypotheticals from situations I’ve seen.)

I know some couples where this was a stressful experience. Multiple people I know were so hopped up on pain pills (2 percocet every four hours, every day, for weeks) they were basically constantly high for the first couple weeks post op. Dealing with what is essentially an opiate addict for a temporary basis is not fun. I on the other hand took 1 percocet and barely had any pain. Why? I have no idea. I was still miserable to be around though!

I also know people who took extended periods of time off of work. Because of this, and because of their inability to do much, the significant others got a bit sick of one another.

Finally, I’m sure some women would think it’s a selfish move to have an invasive elective surgery 3 months before a day she may have been planning since she was 3. I’m also sure some women wouldn’t care. Obviously no one knows this better than you and her.

Insurance / Cost of surgery

I’m not sure where you’re located, and I’m no expert on this, but I believe what insurance you have can change drastically based off being married. My dad does well in his profession, but no matter how well he does his insurance will never rival my mom’s as she works in a school district and is a member of the New Jersey teacher’s association.

I was still covered under my mom’s plan when I had my ACL surgery. A $50,000 surgery cost me probably $75. And that’s 12 months worth of copays, X-rays, MRIs, follow ups, etc. I didn’t pay much for a physical therapist because I did most of my own therapy, but this still wouldn’t have increased my cost much.

Perhaps your wife has better insurance than you and you could really cut down on the overall bill once you’re under her plan. Or maybe they won’t even cover you because of your history. I have no idea. Something to consider.

Depression

This doesn’t get talked about enough.

ACL surgery, really any significant lower body surgery, can cause a great deal of depression. To give you an idea, my ACL surgery left me unable to drive / cook / put my socks on for two weeks, and I couldn’t take a shower for about a month. Many times you feel like you’ve reverted back to being a child. You can’t take care of yourself.

Couple this with you’re severely disabled for a while, mildly disabled even longer, hopped up on a shitload of drugs, most people are in incredible pain, and you have to deal with the fact when it comes to sports it’ll be an absolute minimum of 6 months before playing; where you’re playing competitively in more like a year. Considering how important being active and playing sports seems to be to you, I can tell you you’re pretty much guaranteed to feel considerably down.

Here’s another way of looking at this: Say I was about to get married to a woman and we both had a history of ACL surgery, and she was in your same spot. If she got the surgery before our wedding, already knowing the depression and everything else that came with the surgery, I wouldn’t be happy with her decision. I wouldn’t want a miserable fiance in the immediate months preceding our wedding. And the feeling down isn’t only a couple weeks after surgery. For me, and many others I talked to, it’s more like the entire time, until you’re cleared. It’s not like you’re severely depressed at all times, but it’s noticeably different than your normal demeanor.

You’re constantly thinking:

  • Will I ever be normal again?
  • This sucks, I can’t take care of myself.
  • I just want to bend my leg.
  • I HATE THIS RIDICULOUS BRACE!!!
  • My stomach hurts from all the pills.
  • Will I ever play basketball again?
  • Why me?
  • Am I on track rehab wise?
  • Oh fuck, I just felt a weird pop, do I have to start over?

The list is endless. And it’s a list constantly revolving around me, when you’re gearing up for a day that’s very much about we. And really, if we’re being honest, as best as I can tell most weddings seem much more about her than him.

Overall timeline

While I know you want to get this done sooner than later, 3 months in the grand scheme of things is nothing. Especially in the context of this surgery. Truth be told, and no matter what anyone says to you, you’re not going to feel a semblance of normalcy until 12-18 months. (Leaning strongly to 18 months.) Do not, do not, do not, rush into surgery because you want to get ahead of the game. You’re not Adrian Peterson, and there’s a reason Derek Rose didn’t come back this season.

You need to also take into account,

  • Do I already have my surgeon picked out? If not, how long is it going to take me to find one?
  • When can I schedule my surgery? Maybe you can’t until another month, lessening the amount of time until the wedding. Or even if the surgeon can schedule you tomorrow, do you have your life situation ready for all this surgery entails tomorrow?
  • What type of job do you have? How much time off will you need to take?
  • How much time off will your fiance, or whomever is taking care of you have to take? (My dad had to take 2 weeks for me.)
  • Do I have a physical therapist I like lined up? This was a clusterfuck for me. My first appointment for physical therapy was my therapist’s LAST day. My second appointment was a temp therapist, and my third appointment was the new person’s first day, and I abhorred her. I cannot overstate how royally fucked up this clinic was. Because I did all of my own therapy -and knew what I was doing- this wasn’t a big deal. For a regular person this would set their therapy back over an entire month, which is unacceptable. I started my therapy 8 hours after surgery.

When thinking of your surgery think, “Is this the best 12 month timeline I can go through?” I had a friend who had this surgery and was exactly at the timeline you are. Knew he needed surgery but had a wedding in 3 months. He decided to wait until after his honeymoon. My assumption is most people, as well as myself, would look back on their ACL experience and think, “There’s no way I would have wanted to have to prepare and have a wedding during those first few months.”

Your meniscus

The only issue biologically I’d be concerned with is your meniscus.

One of the reasons I had surgery when I did was it looked like if I kept dicking around there was a chance my meniscus -which the surgeons all thought could be repaired- could open enough to where it would have to be excised. There is a big, big difference between having a repaired meniscus and menisectomy. You want as much of that meniscus in your knee as possible.

No one knows the answer to this except the surgeons, and many times they don’t know for sure until they go inside the knee with the scope. I’d highly recommend you find the answer to this out (if you haven’t). Worst case get some percentages. 50% chance they could repair it? 80? Whatever. I believe with a complex tear you’re likely to have some excised, which probably won’t change if you wait three / four / five months.

However, if there’s a very good chance you could get it repaired, that’s probably the only thing that would heavily sway me into having surgery (much) sooner than later.

The short reason to this whole thing is a repaired meniscus increases the long-term health of your knee dramatically. Arthritis, stability, etc.

Final thoughts

  • Biologically, doing this would be on your somewhat reasonable scale. The other aspects of life would weight much more heavily on my mind, other than the mensicus notes above.
  • Stop jumping / doing anything dynamic. You’ve deduced you need surgery at this point, no sense in pushing things anymore. You don’t want to make the tear in your meniscus worse.
  • Rehab wise you should be working on your strength in a controlled setting, and making sure you have full range of motion.
  • Avoid being in pain as much as possible.
  • Don’t take any one person’s experience too heavily in your mind, including mine. Everyone’s case is different. With my verbosity above you can see how many scenarios can play out. 

When I started writing this I was thinking, “Eh, he could probably get away with having it in a couple weeks, and be pretty good in three months for the wedding.” As I wrote this and gave it more thought, I’m much more at, “I highly doubt I’d do this if it were my wedding. I’d likely wait til afterwards.”

But there’s no right answer. You can see with how long this is how much there’s to consider. It’s almost a pros and cons list type of decision.

Hope this helps you Will. Best of luck with everything.

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Advertisements