ACL Injuries: New Technique
Severed ACLs Are Regrown Without Using Grafts
Anterior cruciate ligaments (ACL) often tear on the sports field, and after a complete rupture they are notorious in their difficulty to get to heal.
On Wednesday, April 6th, doctors at Boston Children's Hospital announced that they have succeeded in reconnecting ACLs in 10 patients using a novel technique.
Their preliminary results at three months suggest that healing an original ACL without the usual grafts may be a viable option in the future.Experts were intrigued but cautious.
Advancement in ACL Surgery
"This is definitely an advance," said Dr. Jo Hannafin, a senior attending orthopedic surgeon at the Hospital for Special Surgery in New York, who was not involved in the experiment.
But, she added, "I don't think we will know for three to five years whether this technique is really effective or not."
Each year, roughly 200,000 people injure the ACL,which runs diagonally through the middle of the knee and provides stability.
In a standard surgical treatment - performed 100,000 times a year - the ligament is reconstructed with a graft from the patient's hamstring or patella.
The New ACL Technique
In a preliminary study to assess safety, Dr. Martha Murray and her team at Boston Children's Hospital performed standard reconstructions on 10 patients with ACL,tears and the experimental procedure, called bridge-enhanced ACLrepair, on 10 others.
In the experimental technique, the surgeons placed a blood-soaked sponge between the ligament's severed ends; the sponge acted as a bridge, helping the ligament grow back together over the next six to eight weeks.
It was the first time the technique had been tried in humans.
No participants in either group had ligaments that failed to reconnect, got an infection, or had stiff knees.
Only the first patient - Corey Peak, 26 - has passed the one-year mark since the experimental procedure. The other patients had it done roughly six months ago.
Three months after the operation, Mr. Peak, a doctoral candidate at Harvard School of Public Health, was back to running on the treadmill. This spring he will play ultimate Frisbee and soccer.
"The real beauty of it is you are getting the native ACLto heal without having a graft," said Dr. Rick Wright, professor of orthopedic surgery at Washington University School of Medicine in St. Louis, who was not involved in the experimental treatment.
Over time, surgeons hope a healed original ligament may perform better than a grafted one. And if the ACLcould be saved, they could avoid harvesting a tendon from the hamstring.
However, repaired ACLs have failed in the past. In the 1980's, surgeons tried stitching torn A.C.L.s back together. The initial results were good, but five years later, less than half of those knees remained stable, Dr. Hannafin said.
Soon, Dr. Murray of Boston Children's Hospital plans to start enrolling participants for a randomized trial that will compare the experimental surgery to the standard reconstruction.
Time will be the ultimate judge of this exciting and new technique.
See the following article to learn more.Doctors Experiment With New Way of Fixing the A.C.L.(NY Times by CATHERINE SAINT LOUIS)