Innovative surgery speeds recovery for working mom.
Barclay Bowen is busy. Really busy. The mother of three children—ages 7, 5 and 3—works full time at a hedge fund. She’s also very active. Bowen runs, takes exercise classes and plays tennis. But her favorite thing to do is ski with her family on winter weekends.
This jam-packed life came to a grinding halt when Bowen tore her ACL (anterior cruciate ligament) while skiing on New Year’s Day. But as quickly as the injury happened, the 38-year-old switched gears to focus on making a speedy, full recovery.
That goal was achieved with the support of her team at the Center for Muskuloskeletal Care (CMC) at Long Ridge Medical Center in Stamford, a state-of-the-art facility that opened in August 2016.
The center is a collaboration between Yale Medicine and Greenwich Hospital, which is part of Yale New Haven Health. CMC offers care for problems affecting the muscles, joints, bones and nerves—from diagnosis to treatment to rehabilitation.
A bump on the bunny slope
A former ballet dancer and seasoned skier, Bowen hardly expected to injure herself while navigating a small slope. But she had her 3-year-old daughter between her knees. “We were wedging our way down the mountain and her ski caught mine. My right knee went one way and my ski didn’t go with it and I heard a pop,” Bowen recalls. “I tried to do a few more turns and my knee was super unstable.”
She suspected that she had injured her ACL, a ligament that connects the femur to the tibia in the knee. Her first step was to call Craig Tifford, MD, an orthopaedic surgeon who specializes in sports medicine and is the medical director of CMC in Stamford. Two of Bowen’s friends had gone to Dr. Tifford for successful ACL reconstructions.
“I got an appointment in short order,” Bowen explains. Though her X-rays were normal, an MRI revealed a complete ACL tear. (All imaging is done at CMC.) “I could put weight on it and walk, but I couldn’t do anything that required lateral or quick movements, or my knee would buckle and give out.”
She and Dr. Tifford discussed treatment options, including physical therapy to strengthen her quadriceps, hamstrings and calves and to help compensate for the lack of stability in her knee. But it would not fix her ACL. “It is impossible to heal on its own,” Dr. Tifford explains. “The ligament basically explodes. It pops or tears and then you have what looks like two mop ends that are no longer connected.”
If Bowen chose not to do surgery, she would need to wear a brace the rest of her life for skiing, tennis and even unplanned activities like playing soccer with the kids in the yard. “I’m in my 30s and I said, ‘No way, let’s book the surgery,” Bowen says.
There were other matters to decide. “It’s not really an ACL repair. It’s a reconstruction,” Dr. Tifford explains. “We’re taking tissue from someplace else and bringing that into the knee, and that tissue becomes incorporated and functions as an ACL.”
The two choices for tissue were to get it from elsewhere in Bowen’s body (near the knee) or using tissue from a cadaver. “Perhaps selfishly, I didn’t want to go through two surgeries, so I opted for the cadaver,” says Bowen. “That’s what both my friends who had surgery by Dr. Tifford had done, too. They were both back 100 percent—skiing and doing all the things that I hoped to do.”
A minimally invasive technique
For the surgery, Dr. Tifford uses an approach called “All-Inside ACL.” “It’s a little different because it’s minimally invasive with three small, quarter-inch incisions instead of one or sometimes two larger ones,” he says. “It takes a lot of practice. Not every surgeon does it.”
Though the “All-Inside ACL” approach doesn't necessarily speed up recovery, there is less pain post-surgery and patients therefore often tolerate physical therapy better in the immediate post-operative period.
Bowen arrived at Greenwich Hospital early on Jan. 17 and was put under general anesthesia. The surgery took about an hour. She was home by mid-afternoon, with a brace she had been fitted with pre-surgery and a pair of crutches. “They give you a pain block to your hip, which helps for the 24 hours after surgery, so the pain doesn’t hit immediately,” Bowen says. “It’s like an epidural. Your leg is super numb, locked into your brace from ankle to thigh. It hurt after the block wore off. I used pain pills for a few days, and gradually, the pain lessened.”
Because Bowen’s right knee was the one affected, she couldn’t drive for four to six weeks, which she says was one of the most frustrating elements of her injury. Fortunately, family members came to stay and help around the house. When she returned to work two weeks after surgery, she relied on Uber for transportation.
Meanwhile, she was diligently working on her physical therapy. She had her surgery on a Tuesday and she started therapy that Friday. “I had a few friends who had this surgery four or five years ago, and back then they let you sit for two weeks. But the longer you sit, the more your muscles atrophy,” she says. “The sooner you get back at it, moving around and everything, the better.”
By the third day, she was able to put some weight on her right leg and stopped using crutches. After a week and a half, the brace was removed.
Bowen went to physical therapy twice a week, typically fitting in a session before work at 7 a.m. “I wanted to get better as quickly as possible. I would ask, ‘What are the three or four home exercises you want me to do?’” Bowen says.
She started running on the treadmill at CMC nine weeks after her surgery and ventured outside on flat roads three weeks after that. Bowen, who lives in a beachside neighborhood in the Rowayton section of Norwalk, was ecstatic to be out in the sun again. She says that it took self-control to not push too far too soon, but she was soon able to run 4 miles.
In March, Bowen and her husband visited a ski resort for a long-planned celebration of their 10th anniversary. Bowen ached to get out in the snow. “We were in the midst of winter wonderland and everyone was snowshoeing or skiing,” Bowen says. She emailed Dr. Tifford to ask if she could try a gentle variation of either. “He highly recommended that I not do either,” Bowen says with a laugh, adding, “What’s nice is that I have direct access to my PT and doctor at CMC to ask these kinds of questions.”
Mountain-ready this winter
Bowen says she also appreciates the flexibility of CMC’s scheduling staff. “Because I work, I might have planned to come in for PT at a particular time, but then a conference call would come up so I’d be always changing things around. I am sure I drove them nuts, but they couldn’t be more awesome,” she says. “It’s a great group and they encourage me and are super proud of the progress I have made.”
That level of attention is key to how all patients at CMC are treated, says Mary O’Connor, MD, CMC’s director and a Yale Medicine orthopaedic surgeon.
“Sometimes it’s stressful to go see the doctor, so one of the things we have focused on is getting all of these important services under one roof and in one location,” she says. “And it’s not just that we want patients to have the best treatment plan. We want them to know that we care about them and their well-being and that we understand their goals.”
For Bowen, that means returning to the slopes this winter. She is on track. In the meantime, she has learned to be a little more patient and to exercise caution. “I won’t pick up my kids and walk up the stairs. I am far more aware,” she says. “You certainly take your knees for granted, but you need them for every little thing, like sitting on your heels to tie your kid’s shoes. I can’t quite do that yet, but I’m almost there.”