Study Shows a Potential Future Alternative to ACL Reconstruction

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One of the most commonly treated knee injuries is an anterior cruciate ligament tear. It has been documented in the past that the ACL has a very limited ability to heal itself; this has made reconstructive surgery the standard treatment for ACL tears. In reconstructive surgery, the torn ACL is removed and replaced with a tissue graft often from the hamstring or patellar tendon. Another surgical option is primary repair, in which, the injured ACL is sutured back onto the residual ACL. This technique is not commonly used because it has been shown to result in continual laxity and instability of the knee.

The study, “Primary Repair Combined With Bone Marrow Stimulation in Acute Anterior Cruciate Ligament Lesions” hypothesized that primary ACL repair with additional bone marrow stimulation could successfully restore stability and function in the knees of athletes with partial tears. It was published in March of 2009 in the American Journal of Sports Medicine and can be found online on their website. The study consisted of 26 athletes, with a mean age of 26.6 years, all of whom were able to undergo surgery within 4 weeks. All participants in the study had athroscopically confirmed partial ACL tears and underwent a primary repair surgery in which there was also bone marrow stimulation of the ACL femoral attachment area. They also had to undergo a specific rehabilitation program post-op. After surgery and rehabilitation, only 19% of the patients did not return to the same initial level of sports activity, in more than half of these patients the determining reason was personal and not due to physical impairment.

The study’s use of bone marrow stimulation builds upon the notion that the use of stem cells in medicine may be at large in the near future. The stimulated cells were mesenchymal stem cells, which have healing capabilities because of their ability to differentiate into specific tissue.

The study concluded that primary repair of an acute ACL tear paired with bone marrow stimulation can successfully restore the knee’s function and stability. Unfortunately the small group size, strict experimental criteria, and lack of a control group/randomization make the study statistically insignificant. Instead, by revealing the possible use of natural healing in ACL injuries, the study serves as a window into what may eventually replace ACL reconstruction in the future.

Although this study has many flaws, it effectively promotes the benefit that may come out of further research into alternative ACL surgery. If successful, this surgery would be a great alternative to total ACL reconstruction. It would theoretically eliminate the decreased proprioception that ACL-reconstructed knees often suffer from as well as harvest site morbidity and harvested tendon weakness.

See the Online Article Here!