By Dev K. Mishra, M.D.
| During the fall and winter months, I typically see a spike in the number of Anterior Cruciate Ligament (ACL) tears, especially among teenage girls. These injuries occur during sports involving jumping and cutting, such as soccer and basketball.
Current Treatment: ACL Reconstruction with Allograft Tissue In 2007, individuals who want a return to jumping, cutting, and pivoting sports require ACL reconstruction, where the ligament is replaced by substitute tissue.  Torn ACL
I have found allograft ACL reconstruction a highly reliable treatment for all patient populations. This method uses cadaver tissue to replace the torn ACL, and carries with it a 94% success rate. Patients typically have less pain than those with their own tissue used for the reconstruction; the tissue is very safe; they return to activities of daily living faster; there is no morbidity from graft harvest; and it is highly acceptable cosmetically. I have used allograft reconstruction in the |
recreational as well as elite level athlete. Patients are usually back to comfortable walking at 3 weeks, jogging at 4 months, tennis at 6 months, and contact sports at 9 months.
Allograft ACL Reconstruction The Future: Growth Factors and Scaffolds What if there was a way to get the native ACL to heal after injury? In the April 2006 Journal of Orthopaedic Research, orthopedic surgeon Martha Murray, MD of Boston Children's Hospital reports that a collagen gel, enriched with blood platelets, can stimulate natural healing of a partial ACL tear in an animal model. Native cells filled in the defect and restored mechanical strength. This research is an important first step in showing that with the right physiologic conditions, it is possible for a torn ACL to heal. Hopefully, this ACL regeneration technique can be used in human patients, using platelets from their own blood |
plasma to create a less invasive ACL repair that would decrease recovery time and give athletes a knee with more normal function. Her team is also trying to enhance the gel to speed the healing process.
Examining torn ACL's at the microscopic level, the researchers were surprised to find that the ligament tries valiantly to heal itself-cells migrate to the wound, growth factors are secreted and blood vessels grow to nourish the new tissue.
In most torn ligaments, a blood clot forms and acts as a temporary scaffold for healing. Cells migrate onto this bridge and begin fusing the ligament ends together. But in ACL injuries, synovial fluid inside the knee joint dissolves the clot, so a bridge never forms. A ligament not bathed in synovial fluid (such as the Medial Collateral Ligament) is able to successfully heal by forming a reparative clot. Biologic repair for ACL tears may be coming soon to an orthopedic surgeon near you. Dev K. Mishra, M.D. 1720 El Camino Real, #116 Burlingame 94010 650-692-1475 1777 Botelho Drive, #110 Walnut Creek 94596 925-934-3536 www.thesoccerdoc.com |
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