FAQs
What if Dr. Schneider is not on my insurance plan?
Dr. Schneider accepts many types of insurance plans that cover knee surgery cost, but in the event that he is not “in network”, accommodations can be made to wave your “out of network” deductible, often resulting in a more economical operation than seeing an “in network” physician. Speak with one of his financial matters employees to discuss this more.
Does Dr. Schneider perform revision (re-do) ACL reconstructions?
Yes. Nationwide, the average re-tear rate of ACLs following reconstruction is between 2-5%. Dr. Schneider is happy to consult with patients whose ACL grafts have failed following primary surgery. Because the placement of the tibial and femoral tunnels must be very precise, often times placement of the tunnels in a new location will solve instability problems. Issues such as implant selection, graft selection, and rehabilitation protocols are also key items of discussion.
I tore my ACL- does not fixing it put my knee at risk for further injury?
Yes. It is well established that ACL-deficient knees are at much greater risk for developing degeneration changes (arthritis). The medial or lateral meniscus often times tears in a knee where the ACL has already torn and is absent, This will lead to increased knee instability, and worse, increased articular cartilage wear.
Do females tear their ACL more often than males?
A definitive yes. This has been a surprising find of the last 15 years. Per hour of sports played, the ACL rupture rate is as high as 10 times greater in females than males. Researchers think this may be due to: weaker core muscles, poor quadriceps development, insufficient “landing” training among female jumping athletes, different angular anatomy of the lower limb, varying bony constraints within the knee joint itself, hormonal interactions (estrogen’s effect upon ligaments), and poor conditioning, to name a few.
All told, there are many reasons for females (particularly adolescents) to engage in female-specific conditioning and jumping/landing training. In addition, for the young woman who has undergone ACL reconstruction, a specialized rehabilitation is key. At Cornerstone Orthopedics we have a specialized program for females, as do the physical therapists we collaborate with.
Should I do any therapy before surgery?
Yes. We call this “Pre-Hab”…or “Pre-surgical Rehabilitation.” Pre-Hab restores range of motion, decreases swelling, and increases muscle tone around the knee. This has tremendous benefits following surgery, minimizing pain and enhancing the speed of recovery.
What does my recovery look like?
Please see the pdf document “Post-op recovery”.
How soon can I be seen, how soon can I have surgery?
We make a very strong effort in trying to see any patient with a torn ACL within a week of calling for an appointment. Depending on the timing of the injury, we will then proceed with surgery within two weeks for typical cases.
Do I have to have an MRI before surgery?
An MRI is not absolutely mandatory, but an MRI often gives additional information not able to be gleaned from a physical exam alone. Most patients are sent for an MRI, but only at a high-quality MRI center. Many MRI’s are sub-standard, and unfortunately can be a waste of time/money.
What about using cadaver graft for my reconstruction?
Utilizing cadaver tendon (from a deceased donor) has become quite popular over the last 5 years. Sadly, reports are surfacing that failure rates using cadaveric tissue is many times higher than using one’s own tendons. Therefore, I do not routinely use cadaveric tissue, but prefer using the patient’s own tissues. Cadaver tendons are reserved for the very young (less than 14 years), the more “seasoned” athlete (older than 45), and multi-ligamentous knee reconstructions.
If I use my hamstring tendons for ACL reconstruction, will they grow back?
There is a long-held belief that “hamstrings always grow back!” This is not true unfortunately. Probably in the majority of cases the hamstring tendons do re-grow to a noticeable degree, but they are probably never as bulky and robust as the original parts. Plainly stated, many studies have shown that patients who donated their own tendons have excellent strength and speed following ACL reconstruction. This has been the experience of Dr. Schneider as well.
I’ve skied my whole life and never hurt my knee, and then I had this little accident and tore my ACL. What gives?
It is difficult to explain how freak accidents can result in such catastrophic casualty, but clearly minor accidents can cause major disabilities.
Should I wear a knee brace after surgery?
This too is controversial. There is a general consensus that even today’s, advanced design knee braces do not confer a protective benefit to patients. Having said that, many of our patients are fitted with a knee brace for “peace of mind” in the calendar year following surgery.
My friend used this really fancy cooling sleeve after surgery and swears by it. Should I use it, even if my insurance company won’t pay for it?
Many patients are delighted with their knee-cooling sleeve. It provides pain relief, decreases swelling, and probably provides a welcome distraction. We’ve heard on countless occasions, “Tell your patients to get it…it’s worth the money!”
I don’t live in the area, but would consider coming to Denver for surgery. Is there a program for that?
We have a program for out-of-town patients. This starts with a telephone consultation with Dr. Schneider and a discussion with financial staff, if desired. Out-of-town guests can often be accommodated with single-trip office consultations and surgery that can be paired within days of each other. We have arrangements with local hoteliers for discounted rates for patients and their families. Following surgery, post-operative care can be arranged with your local therapists and physicians to minimize back and forth trips to Denver/Boulder.
When can I return to sports after surgery?
The general time markers are:
- Discontinue crutches within 3 weeks
- Discontinue post-operative knee brace within 5 weeks
- Walk without a limp within 6 weeks
- Straight-ahead running at 2 months
- Sports-specific activities at 3 months
- Unlimited sports at 6 months with custom knee brace
- Forget you had surgery at 12 months
I’ve heard about double-bundle ACL reconstruction- does Dr. Schneider perform that?
Double bundle ACL reconstruction has been performed increasingly over the last 5 years, but is still relatively rarely performed in the US. The clinical value of this more time-consuming, more expensive, and more complicated surgery has simply not been established. Dr. Schneider has performed both ACL and PCL double bundle reconstructions when warranted, but until more data justifies the added costs, morbidities, and “headaches”, they will not be routinely performed.
Does my insurance company cover Dr. Schneider’s Physician’s Assistant (PA)?
All insurance companies have engaged in severe cost-containment programs over the last decade. Anyone paying attention in the American marketplace is aware of the annual trimming of benefits that is occurring. What once was routinely covered is now rejected in total. A great example is surgical assistance fees. Many insurance companies have decided to never pay for a surgical assistant (such as a PA, or Physician’s Assistant). They may hide behind the ruse that a PA is “not medically necessary”, and then reject the claim for payment, leaving the patient to pay. Other insurance companies will only pay for “in-network” assistants, which can be a clever smokescreen, since they have no assistants in the entire state who are “in-network”.
Suffice it to say, Dr. Schneider uses an assistant for every ACL. Typically the assistant is Kurt Noteboom PA, who has assisted Dr. Schneider in hundreds of ACL reconstructions. More and more frequently patients are asked by their insurance companies to pay part, or all of, the assistance bill. Dr. Schneider values the expertise of his assistants, and expects them to be paid in a timely fashion at market rates, notwithstanding insurance companies increased attempts at improving their bottom line.