Rushing to get surgery, anxious about getting a basic pateller graft with no LET or internal bracing

(TLDR at bottom)

So not sure where to start. I recently tore my ACL at a rough time in life. I used to have a corporate remote career with good health insurance and everything, but through my 20s, fell in love with thru-hiking (I backpacked 8,000 miles in like 4 years) and decided to switch careers. I saved up as much money as I could and started at a maritime academy to become a merchant mariner. Had to quit my job, get on Medicaid, and try to make it through the accelerated 3-year program with as little debt as possible. The whole goal of this was simply to be able to have more time for long-distance backpacking - with the new career I could get stretches of months off a time consistently - hike thousands of miles in the summer, and ski and climb in the winter.

Unfortunately, with under 2 years left in school, I just fully ruptured my ACL 10 days ago.

I was the fittest and strongest I’d been in my life, at 30. I played volleyball and soccer weekly, rock climbing 2x a week, running, mountain-biking, pickleball, going into my 3rd season of skiing, still was backpacking 30-mile days the week before, lifting 5x a week, etc. All that just seems like it is out the window now.

I’ve been emotionally getting over the trauma of getting egregiously shoved by some guy for no reason, and all the upcoming plans I had and stuff I am about to miss out on, and doing this totally alone without my good health insurance, but I can’t stop freaking out about the surgery. I have some aspects of OCD and just cannot stop ruminating about how to make sure my surgery is 100% optimal. I have this overwhelming looming fear about how I will never be able to hike the same way, like hiking 30-40 miles per day for days on end, or do demanding technical off-trail routes, etc. I’m petrified I’ll have knee pain for life and “my knee will never feel the same.” Most of the people I know who tore their ACL had this experience where they have complained about their knee ever since, don’t play sports or ski anymore, etc. If I can’t get back to rigorous thru-hiking, then I would honestly drop out of school.

In 10 days I managed to fight through all the Medicaid BS, get an initial appointment, MRI, talk to a surgeon, and even schedule the surgery for under 3 weeks from now. I didn’t want to rush, but the problem is that the program I’m in is ridiculously niche and inflexible with strict timing issues, and if I can’t do a (quite physically demanding) internship starting at the end of April 2027, then the school will delay me an entire year that I simply can’t afford. I need to be able to work on a commercial ship, doing things like grunt deckhand work - chipping, painting, going up a shitload of stairs, standing for 8-10 hours straight at the helm - maybe during rough/unstable seas, etc. Because of this, I have been rushing to do the surgery ASAP to give me the best chance of recovering in time. This also means I have to be back for in-person classes 5 days out from surgery, since they also have a rule of mandatory attendance with no exceptions, and missing class would also set me back a whole year.

Another tough thing is that I live in a pretty remote area with not many medical options. I thought I found one of the better regarded surgeons in the area and just had my consultation and left feeling more anxious than before. The whole process was so rushed, I had so many questions I didn’t get to ask, he was looking at his watch several times, kind of forcing the appt to end quickly. He also wouldn’t say which graft type he does the most and “that he can do whichever graft I want”, etc. I had decided I was interested in a quad graft for best odds of hiking the same again, but I coaxed it out of him that he mostly does patellar and hamstring, so I booked the surgery for patellar graft.

There was no discussion of my goals, my activity level, BEAR or fertilized surgery or LET or internal bracing, etc. The MRI showed some signs of additional damage like bone bruising, lateral femoral sulcus deepening, suspected medial/lateral meniscocapsular separations, and medial femoromeniscal ligament disruption - but he just kind brushed that aside and didn’t say if it would affect how he does the surgery. We didn’t even look at the MRI together at the consultation. I told him I don’t have full ROM and he wasn’t concerned. Before I could ask any more questions, he was out the door and the surgery booked.

I left with so much anxiety and doubt, and have had a shitty feeling lately about how most doctors just care about money, etc. How can you be an orthopedic surgeon and not know about all this stuff that you can find from just a week on the internet (LET/internal bracing, etc)? How can you not ask what kind of activities I want to get back to doing? I get the feeling they are just gonna do the surgery and throw me out to the wolves after.

The issue is that he is already one of the better-rated surgeons in town who does ACLR, and it is going to be a pain through Medicaid to get a second-opinion approved, another consultation scheduled with another surgeon, let alone another surgery booked on the same timeline. At this point I’m already so worn out and the hard part hasn’t even started. I’ve also been trying to get pre-hab scheduled but none of the good PT places in town accept Medicaid already and the phone-tag and not answering calls is exhausting.

This whole process has been so frustrating and overwhelming and gotten me really down. I feel like this seemingly small injury just flipped my whole life upside down. I know this is rambling, but really wanted to vent.

I guess my main concern is about dealing with rushed surgeons who don’t let you ask many questions, and speed-running this whole process. Should I stop rushing to do the surgery and give up on the goal of being in working condition in 6 months? Or should I stop ruminating about all this new tech like internal bracing, LET, BEAR, fertilized graft, etc. and just accept that this is what I will get? Or should I push the surgeon to do one of these things he doesn’t normally do?

I keep comparing myself to other people I found online who had world-class surgeons who worked on the Olympic ski team, or did Tom Brady’s ACLR or whatever, and feeling like I am gonna be worse off for just getting the generic patellar graft. I found a few examples of other thru-hikers who got back to the same level, but they had quad grafts and internal bracing, so I’m worried that I should get the same. The anxiety is killing me, it is really hard going through this alone and wondering if all the things that formed your identity will never be doable again.

TL;DR
- how realistic is it to be doing a physically demanding job 6 months after surgery as a 30-year old?
- how did you stop ruminating about the optimal surgery?
- how to deal with rushed doctors and Medicaid, finding a good place for PT that accepts it?
- any words of wisdom to return to extreme/endurance activities like ultra-running/thru-hiking?
- what to do when your surgeon doesn’t know much about or do any of the newer procedures like LET/internal bracing/etc? Just accept it and hope for the best with a standard patellar graft?