acl regrowth

MRI following primary repair of the anterior cruciate ligament

Primary repair of the anterior cruciate ligament (ACL) is being performed increasingly in the treatment of acute proximal ACL ruptures. Advantages of ACL repair over surgical reconstruction with a tendon graft include preservation of the anatomy and proprioceptive function of the native ACL, and therefore, faster rehabilitation. The addition of an internal brace protects the repair during ACL healing and can increase the success rate of the procedure.

Given this evolution of ACL surgical treatment, radiologists should be familiar with the new repair techniques and their appearances on postoperative imaging.

In this article, we describe two different surgical techniques for primary ACL repair, dynamic intraligamentary stabilisation and internal brace ligament augmentation, and provide an overview of the normal and abnormal appearances after this type of repair at magnetic resonance imaging (MRI) follow-up.

May 06, 2019

https://www.clinicalradiologyonline.net/article/S0009-9260%2819%2930157-6/fulltext

Although Canada is about a decade behind adopting current orthopedics with respect to these types regenerative medicine procedures, radiologists can prepare in advance. 

The Canadian radiologist who interpreted my regrown ACL MRI did so incorrectly, however when reviewed by those familiar with current procedures it was exactly the mottled appearance expected for that period of time.

Skiing after InternalBrace Ligament Augmentation

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Posting this for the Snowheads ski forum thread

https://snowheads.com/ski-forum/viewtopic.php?t=130739

This is the first time I’ve went back to Lake Louise since being injured there. One of the reasons I wanted to go was to overcome any mental barrier remaining about skiing there.

This photo unintentionally has the ridge & shelf where it happened way in the background. I plan to get up there, but have been skiing with looser buckles to train through another problem I experience skiing which requires different runs that I would usually be on. Waiting for the next day it softens up to go back before the hill closes for the season.

ACL Regeneration in 8 year old link

20180505 ACL Regeneration in 8yr old patient.JPG

Prior to the brace I noticed people look at me more; seems the limp was really noticeable.  They still look at me with the brace too.

 

May 5, 2018

Also found another article on ACL Regeneration, this time in an 8 year old with mid-substance rupture, where "conservative treatment with a brace led to a stable knee with regeneration of the ACL on both the physical examination and MRI after 5 years."

https://www.rpajanssen.nl/images/user/files/JKSR%20ACL%20healing.pdf

 

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I email my doctor one of the articles, asking for information on the % of ACL tear, and confirmation whether clot retention is needed to facilitate ligament healing, and if the bending exercises they prescribed will work against the bodies natural healing mechanism.  I stop doing the exercises pending response.

 

May 6, 2018

Bent my leg while I was sleeping, pain returns.

No reply from email yesterday.

ACL regrowth BEAR trials (bridge assisted ACL Repair)

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After first finding an ACL healed itself, the 2nd thing I found were the BEAR trials run Boston Childrens in these two articles from 2016:

20180428 BEAR Stack article.JPG
20180428 BEAR Boston Globe article.JPG

https://www.bostonglobe.com/sports/2016/03/23/new-surgery-could-revolutionize-knee-repairs/BJISuh60AYKYTKWPwaYFWP/story.html Boston Globe

A safety study had been done on 10 patients, all reported “doing well, with knees working as well as knees treated with ACL reconstruction.”  The 1st patient surgery was Feb. 2015 (> 3 yrs ago), for Corey Peak, who also tore it skiing.  He concluded that it was a better option to treat a torn ACL; within 3 months post-surgery, his MRI showed that his ACL had started to naturally knit together; he was jogging on a treadmill. Soon after, cycling to work. 

20180428 BEAR trial 2 brochure explanation.JPG

Bridge Enhanced ACL Repair - How it works:

When viewed under a microscope, ACLs still have active cells and blood vessels after injury.  The ligament itself works hard to heal, however the synovial fluid — the lubricating substance that exists inside of all joints —washes away the blood clot that serves as the initial connection between torn tissue ends in other parts of the body. 

Conventional treatment for an ACL tear involves removing the torn ends of the ligament that’s trying to heal itself, & fabricating another from a tendon graft, usually done by stripping away good tissue (hamstring or patella).  Patients who had 1 injury then have to recover from 2 separate injuries—the torn ligament + the uninjured area where the graft was taken out.

Whereas a traditional reconstructions involves removing good tissue for a graft from another part of the body to fabricate an ACL, BEAR allows patients to re-grow their own ACL. This resulted in both quicker #recovery and fewer long-term complications than the traditional ACL amputation & reconstruction.

An estimated 150,000 ACL tears still occur every year in the USA. “ACL re-tear rate can be as high as 20% for teens.  Up to 80% of patients develop arthritis 15-20 years after surgery.”

Given the eligibility criteria timeline, I need to figure this out fast, as I was at 38 days, and I didn’t want unnecessary ligament removal.

Orthopedics - Intrinsic Healing of the Anterior Cruciate Ligament in an Adolescent

20180430 12 year old regrows ACL fracture.JPG
20180430 12 year old regrows ACL g rupture.JPG

Apr 27-29

The majority of the weekend I spent searching anterior cruciate ligament repairs & learning what an ACL repair is, and the 1st article I found was how a 12 year old boy suffered a complete traumatic rupture of his ACL, which intrinsically healed. 

 

You can find the article

“Intrinsic Healing of the Anterior Cruciate Ligament in an Adolescent”

in The American Journal of Orthopedics, August 2015

https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/ajo04408e294.pdf

20180430 12 year old regrows ACL h 29 month.JPG
20180430 12 year old regrows ACL intact.JPG
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