Wait no more: ACL repair, delayed weeks by coronavirus, a success

Fix for January ski injury happened the day of elective-surgery reopening at UCHealth Steadman Hawkins.
June 18, 2020

Kim Tyler had skied Schoolmarm, a top-to-bottom green run at Keystone Resort, “a gazillion times,” as she put it. On Jan. 2, the run would be hers and her family’s warmup before moving on to more challenging terrain. But she caught an edge, and down she went, and when her right ski’s binding didn’t pop, something in her knee did. Her day was over.

Young and active

Tyler, 42, is a physician who did her rheumatology fellowship at UCHealth University of Colorado Hospital (UCH) on the Anschutz Medical Campus. She’s active and has had her fair share of bumps and bruises.

It’s just a sprain, she thought. It’s fine. I’m a doctor.

Kim Tyler with daughter Ainsley, son Andon, and husband Alejandro on the slopes. Kim hurt herself on the slopes and then her ACL repair was delayed because of the coronavirus.
Kim Tyler with daughter Ainsley, son Andon, and husband Alejandro on the slopes. Ski season had been cut short by the coronavirus and Kim’s ACL repair delayed. Months had passed by the time she finally got her knee surgery in late April. Photo courtesy of Kim Tyler.

A week later, the pain, swelling, and stiffness hadn’t abated. More concerning was that the knee buckled. The doctor recognized she needed to consult a surgeon. She did so at UCHealth Steadman Hawkins Clinic – Denver, where Dr. Jason Dragoo – an orthopedic surgeon, head team physician for the Denver Nuggets, and the director of the UCHealth Inverness Orthopedics and Spine Surgery Center – checked out Tyler’s knee. He had her in an MRI machine the same day. The scan showed that she had completely torn her anterior cruciate ligament (ACL) and partially torn her medial collateral ligament (MCL). The plan: wait six weeks while the MCL healed on its own, then surgically reconstruct the ACL on March 17.

ACL repair delayed

On Saturday, March 14, U.S. Surgeon General Jerome Adams tweeted that hospitals should consider stopping elective surgeries. Colorado Gov. Jared Polis’s wouldn’t issue his order barring elective surgeries statewide until March 19 (the order would be in effect from March 23 until April 26), but UCHealth was taking no chances. The day before Tyler’s scheduled surgery, Dragoo’s office called to postpone her surgery.

Tyler agreed with the decision. She had been watching the COVID-19 numbers climb; she was involved in her own clinic’s work to adapt care for the coronavirus pandemic – as at UCHealth, that involved a quick ramp-up of telehealth consultations, social distancing, masks, the spacing of appointments, and much more. She understood the importance of minimizing the coronavirus’s spread as well as of preserving health care capacity for a possible flood of critical coronavirus patients. Although her surgery would happen at the UCHealth Inverness Orthopedics and Spine Surgery Center collocated with UCHealth Steadman Hawkins Clinic – Denver, a transfer to UCH could be in the cards in the unlikely event of complications. Putting off her surgery was definitely the right call.

Still, she said, “My heart kind of dropped.”

Injury hindered quality of life

She couldn’t jog; she couldn’t hike. She could walk on flat ground and make it up stairs – slowly. For exercise, she was limited to a stationary bike and a rowing machine. She had to be extra careful because, while her tumble on Schoolmarm had not damaged her meniscus (the knee’s cartilage padding), one wrong move without the knee’s stabilizing ACL ligament could change that, and with possible long-term osteoarthritic consequences.

With mom literally lame, her daughter Ainsley, 13, and son Andon, 10, became versed in the finer points of laundry management, dishwasher loading and unloading, and even lawn fertilization (husband Alejandro supervised while taking over various other household tasks). The good news was, Tyler’s knee wasn’t causing more pain as the weeks passed. That wasn’t the case for everybody, Dragoo says. Many who awaited elective surgeries on their hips, knees, ankles and shoulders were hurting.

“Imagine you were in severe pain and couldn’t get care for it, and you had to wait a month or longer,” Dragoo said. “We realized that people were getting much worse on the pain-severity scale.”

Elective surgeries resume

When the Colorado governor sanctioned elective surgeries again on April 26, UCHealth was ready. Dragoo’s team scheduled Tyler’s surgery April 28 – the day the UCHealth Inverness Orthopedics and Spine Surgery Center reopened to patients.

By the time that day arrived, she had already done her best to self-isolate for a solid week, as Dragoo’s team has requested. She and had also done the drive-up COVID-19 test Dragoo’s team had prescribed. It had come back negative.

Dr. Jason Dragoo
Dr. Jason Dragoo

The new building looked the same from the outside, but things had changed dramatically within. Just inside the sliding-glass doors, Tyler answered screening questions about her health and had her temperature taken. Everyone, herself included, wore a mask. The place was quieter: appointments were scheduled with longer gaps between them. Waiting room seats were spaced at six-foot intervals.

Other differences were less obvious. The intense infection control and cleaning familiar in operating rooms was now standard in clinic areas. Clinic rooms were sterilized between patients. Patient flow had been altered such that there was one-way traffic so they wouldn’t encounter one another. Clinic teams had been arranged into three pods that functioned independently, such that an infection among providers in one pod would not shut down the other two. The building’s ventilation system had been reconfigured such that air was pumped straight outside rather than recirculating.

Delayed ACL repair resumes safely

The changes extended to Tyler’s surgery. To eliminate the risk of spreading the coronavirus through aerosols and respiratory secretions that can fly forth during the setup of the intubation required for general anesthesia, Dragoo’s team opted for a combination of a spinal block and propofol. She would be out of it, but not totally out, when Dragoo began a surgery that came off without a hitch.

“Everything went great,” Tyler said. “I think everyone was really happy to be back at work, which I can completely understand. Everyone was so supportive.”

By her two-week postsurgical appointment on May 13, she had regained full range of motion and, thanks to improving strength, was on the cusp of abandoning her crutches. Tyler’s physical therapy appointments happened in the capacious first-floor training and rehabilitation area. There, appointments as well as treatment tables were now widely spaced, too, and with OR-class sterilization the norm between patients.

Patients are streaming back, Dragoo says: UCHealth Inverness is doing 25 to 30 procedures a week – more than usual as backlogged patients join new ones. He and colleagues are confident that their many coronavirus-safety measures will continue to let them help patients with surgeries that, while “elective,” they very much need to be done.

Come winter, Tyler intends to be back on the slopes. Her first stop may be Schoolmarm. This time, it’ll really just be a warmup.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.