To Cut or Not to Cut: A story about my ACL

Part 1: My physical and mental experiences

By: Joe Boffi Catalyst S.P.O.R.T. Co-Founder

 

“To cut or not to cut?” This question was on repeat in my head for several years. I suffered an ACL injury in 2013, and despite many hours of quality rehab, my knee pain continued to recur, so I began to look at surgery as my next course of action. ACL (anterior cruciate ligament) reconstruction has become more and more common.  Even though this surgery is common, it may not always be necessary or successful.  The hardest part for me, was deciding whether surgery was the right choice. Just like when starting a business, “knowing my why” helped in the decision-making process. Knowledge of what makes surgery successful helped inform my decision and gave me a framework to utilize post-surgery. 

 

My Why:

There was a lot of pondering of thoughts and swirling emotions that preceded the decision to have surgery, not to mention countless hours of conversations (with doctors, colleagues and people who have had the surgery), along with my own research.  My two most consistent emotions were anger and frustration.  Anger towards my injury because it could have been prevented.  While kickboxing, a training partner performed an illegal technique and caused me a torn ACL, torn meniscus, chrondromalacia patella, and a baker’s cyst.  Frustration arose often because no matter how much movement therapy I performed (if you know anything about the resources available at Catalyst, you know I was doing stellar stuff), I still couldn’t train the way wanted to. 

 

Competing in Muay Thai and Brazilian Jiu Jitsu requires a ton of weekly hours mixing high, medium and low intensity training.  Even reaching a fraction of my former training intensity and volume would cause my knee to buckle, my baker’s cyst would swell, and arthritis would flare.  Mentally, I was always restraining my effort and focus during training because my knee injury was always in the back of my mind.

 

After about 3 years’ worth of stabilizing, mobilizing, and strengthening my body I could live a relatively pain free life.  I’d stay pain free, as long as my daily activities were mild, and my strength & conditioning.  My ACL specific training looked like this:

 

  • Strengthen the foot
  • Mobilize the ankle
  • Stabilize the knee
  • Strengthen the quad/ham/glute
  • Mobilize the hip
  • Stabilize & Strengthen the core

 

I could do most exercises without aggravating my symptoms.  Even without an ACL, I was able to achieve personal records in back squat, front squat, clean & jerk, and snatch.

 

However, if I started to bounce around on my toes to box or get on the ground to wrestle I’d often feel the joint move, grind, click, and slip. It was almost as if my tibia and femur were having their own fight.  The result of this would always be a flare up. 

 

In an attempt to get a conclusive recommendation for, or against, surgery, I consulted with a handful of doctors and movement specialists who I’ve worked with over the years, all of whom I have a tremendous amount of respect for.  The consensus came back split.  Half said I didn’t need surgery, and the other half said I was a good candidate for surgery.  The overarching theme from everyone was if I stopped being an athlete, and stopped doing the things that I love, I’d be physically fine and not need surgery.   To me this was not acceptable.  I thought, “How could this be…? My injury wasn’t caused by years of moving improperly, my injury was caused by a traumatic event.  Why should I have to give up the things I love?” The sports I practice aren’t just recreation, they are lifelong passions. 

 

As it turns out, after copious amounts of reading, I felt that with my current physical base, the fact that the injury was caused by trauma, and that I intend to go through lengthy 9-month rehab before “returning to sport”, I should end up with a successful outcome from surgery.  There were even a couple of doctors that were willing to agree with my assessment. This was surprising because most doctors won’t commit to saying if a treatment will resolve an issue.

 

After all my research I’d like to leave you with some thoughts to ponder before making your decision: 

 

  • Was your injury caused by trauma or wear and tear from dysfunctional movement patterns? Dysfunctional movement patterns can be caused by weak, unstable or poorly coordinated muscles. If this was the cause, you might want to seek the help of a qualified movement specialist before going further.  Surgery may not be for you, as it will likely not resolve the underlying dysfunction. I’ve got the best short list of who in world should assess your movement, and I’d be happy to connect you.
  • Are you committed to a very long and intensive rehab (9 months)?  If not, this surgery isn’t for you.
  • Can you perform my physical prerequisites for surgery that I’ve listed below? They are prerequisites for a reason.
  • If this is a re-tear you should look to the above three bullets and apply them to your first surgery and see how they currently apply.   Then ask yourself why did it re-tear and if surgery is right for you.

 

How to pick a Surgeon & Physical Therapist

Picking a good surgeon (they are cutting you open) and physical therapist is important. A good physical therapist may even be more important because he or she is so directly involved with your long-term outcome.  Finding a knowledgeable and dedicated physical therapist one of the toughest parts of the process, if you don’t find the right PT you’re jeopardizing the success of your recovery.  Working backwards from my recovery to surgery, I formed a team of therapists that would be guiding me through my rehab.  At Catalyst, we are fortunate to have so many amazing clinicians and therapists that forming my team was a simple in-house decision.  If you’d like help forming this team I’d be happy to chat over email. 

 

From my rehab team, and a few other physical therapists that I trust, I got a handful of recommendations.  After meeting with and speaking to my perspective cutters, I went with Dr T. Sean Lynch at Columbia Doctors.  While performing my research on him, I found he is highly regarded in his community, and he often works with an athletic population such as myself.  His consultation appointment was more thorough than any of the other surgeons, and his surgery recommendations were in line with most of my research.   

 

Speaking of research, make sure to read up on the different graft sites, as well as the use of a cadaver.  This way you can have conversation about the graft site and what procedure he/she uses most often and what is recommended for you.  This is discussion is important.  For example, if you are a mason worker or someone who spends a lot of time on their knees, a patella tendon (BTPT) autograft is probably not an optimal choice due residual anterior knee pain. 

 

 

 

Are you as ready as you think?

Since I started to write this blog, about 5 days have passed since my surgery. I’m not going to get into my recovery yet, but immediately after surgery I realized that there are a few physical prerequisites.  I’d almost say that these prerequisites are mandatory before having surgery.  They will aid you in continuing your life and make you a little more self-capable during your initial recovery.  Being able to perform these prerequisites will also make physical therapy more effective and productive.  If you feel your physical therapy is being effective and productive, you are more likely to do your exercises more often and stick to a long-term plan. This is one of the keys to a successful surgery. On top of that, you’ll need to learn how to do some of these things after you’ve been under the knife, so why not learn them before you’re uncomfortable and in pain?  If I couldn’t perform these tasks, the first two weeks after surgery would have been miserable. 

 

Here are what I believe to be physical prerequisites to surgery:

 

  • You need to be able to do some form of push up, or straight arm hold with your body off the ground, like in a dip station.
    • Having the ability to hold your body up with just your arms will be useful for sitting down & standing up (think bathroom), using a bannister while going up/downstairs, and manipulating yourself on the bed/coach/floor/chair.
  • Squatting on one leg down to a 12-18-inch box.
    • Again, this will be super useful sitting and standing, going to the bathroom, getting down to and up from the floor, or just maneuvering yourself in less than ideal situations.  You should be able to perform this on both legs.
  • Executing a proper toe touch with extended knees.
    • Being able to touch your toes while properly extending your hips and producing global spinal flexion is something you should be able to do anyway.  But you’ll thank me that you can do it when you try to put on your socks and shoes with a locked knee brace, or when your knee is so inflamed you can’t bend it.  
  • Knowing how to isolate and flex/eccentrically load your quad and hamstring.
    • In the beginning, most Physical therapy exercises require you getting those muscle to turn back “on”.  Due to the trauma that your body receives during cutting, many muscles have a form of amnesia and are difficult to get working again. Instead of wasting time trying to figure out what your therapist is trying to get you to achieve, you’ll actually be executing. 
  • Properly producing abdominal pressure.
    • Being able to produce abdominal pressure will help alleviate tension in the lower back and allow your hamstrings to contract properly. It will also help you produce full body tension and push yourself during therapy.
  • Prehab strength and stability training of the knee.
    • Find a clinician who specializes in authentic human movement (someone trained in Immaculate Dissection, FRC, or PRI is where I’d look) and do 3-6 months of exclusive knee prehab.  This leads to a fast paced and thorough recovery.

 

 

 

The time had come to cut…

During the late morning of February 9th 2018, I walked into New York Presbyterian/Columbia completely fasted, starving and ready to get cut.  I entered this place of healing with the mission of improving my life, or at least my knee. With my first step into the lobby, I was slapped in the face.  Every delicious food aroma that you could think of seemed to permeate the air.  Scents of warm fresh baked bread, crunchy bacon, and fragrances of coffee from around the globe, all tortured my soul.  Now come on NYP, didn’t you tell me to come here fasted? And now you torture me with the smells of what can only be the world’s best bakery…  This seemed like a design oversight during the hospital’s creation.  My conviction started to flag, but despite the cafeteria’s best efforts to spoil my plans - I had an ACL reconstruction and a partial meniscectomy…  

 

I’d like to thank you for taking the time to read some of my very genuine feelings and putting up with some of my ranting.  I’d be happy to discuss any of this further or help make any referrals.  You can email me at [email protected] and to learn more about Dr. Lynch head to his website by clicking here

 

If you’d like to hear more about my recovery, Click Here for part 2 of To Cut or Not To Cut

 

 




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