In 2006, an article in Science Daily reported on a promising technique that could one day replace ACL surgery. The technique described in the article involved injecting collagen gel, enriched with blood platelets from the patient, into the area where the ACL tear had occurred. This collagen would then it was theorized, act as a bridging material for the torn ligaments to fill. Meanwhile, the platelets would supply growth factors that would support this bridging. This technique had only been explored in animal models at the time, but nonetheless was exciting. Dr. Martha Murray, who led the team conducting the study, hoped that the technique would provide a less-invasive, more effective form of ACL repair, and that the collagen gel could eventually be used to regenerate cells damaged by osteoarthritis.
Building on this information, this past March 2009 researchers published an article in the American Journal of Sports Medicine that shows further promise for the utility of collagen-platelet composites. The study, titled “Collagen-Platelet Composites Improve the Biomechanical Properties of Healing Anterior Cruciate Ligament Grafts in a Porcine Model,” compared surgical outcomes in porcine subjects. The pigs were either given a traditional ACL repair, or an ACL repair with a collagen-platelet composite (CPC) around the graft site. Results are very promising. The CPC was well tolerated, as it was pre-treated with a pepsin product to help reduce rejection. Animals who received this treatment showed a stronger recovery from their ACL repair. Those who received the CPC had no observed necrosis in the graft, and had a lower level of knee laxity (instability) post-op.
The results of this study are exciting, and reinforce the thought that collagen support in ACL repair could hold promise as a future treatment in human patients. There are however a few caveats, since the grafts were used in animals they were not sterilized prior to grafting. There is no way of knowing whether the sterilization process that would be necessary to put an allograft into a human would reduce the efficacy of the treatment. Additionally, there remains the chance that the process of wound recovery, and the physiological differences between the porcine model and that of a human, contain variation that could influence the extent to which the treatment is effective. Moreover, the technique has not yet been tested in a human.
The results of the study still show that although the enhanced surgical graft was effective, that there is no substitute for a healthy, injury-free ACL. Thus, even with such exciting technologies beginning to emerge, prevention should still remain a focus as medicine moves forward.
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