Developments in ACL Repair

[Stryker]

I shared this post in another forum.

Last season, one of my worst fears as a parent of a college athlete was realized as I watched my daughter land oddly after jumping to secure a soccer ball and collapse to the ground. She was diagnosed as sustaining a torn ACL and sprained MCL that required surgery. While her school helped arrange a quick surgical consult with a local surgeon for standard ACL surgery, my wife performed her own research and came across a new surgical procedure that neither the surgeon, the school's training staff or athletic department had any familiarity. The procedure is called Bridge Enhanced ACL Repair or BEAR and in simple terms allows the ends of the torn tendon re-grow together with the help of an absorbable collagen implant. Unlike standard ACL re-construction, the procedure does not require a hamstring graft or graft from a cadaver. The recovery time is similar to that of standard ACL re-construction but does require that the patient remain in a brace for a few weeks longer than the normal procedure. Preliminary studies suggest that the BEAR procedure will lead to less osteo-arthritis in the knee. It looks like the BEAR procedure may be the future of ACL repair. My daughter elected to have the BEAR procedure in November and is well on her way to full recovery and playing for her team in August.

Since most parents and physicians we have spoken to have had no knowledge of this procedure, I felt it important to share with a community of people that care about college sports and student athletes. Attached are some preliminary studies regarding the procedure.

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure: An Early Feasibility Cohort Study - PubMed (nih.gov)

Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study - PubMed (nih.gov)

[Ralph Turner]

Stryker, thanks for the post.

However, the links to the articles that you reference did not post.

If you cannot get the links to post, please Personal Message (PM) me here or email me and I will try to assist.

[Ryan Scott (Hoops Fan)]

This is good news.  I had a 90% tear of my MCL in high school and elected not to have surgery because of all the extra complications.  It healed on its own and it's good as new in terms of strength, but I definitely have more pain, etc.  This procedure seems like the best of both worlds - natural healing and some surgical repair.

Thanks for sharing.

[Stryker]

I’ll try to repost the  links to the studies are below:

https://pubmed.ncbi.nlm.nih.gov/27900338/

 https://pubmed.ncbi.nlm.nih.gov/30923725/

Hopefully they work.

[Ralph Turner]

I’ll try to repost the  links to the studies are below:

https://pubmed.ncbi.nlm.nih.gov/27900338/

 https://pubmed.ncbi.nlm.nih.gov/30923725/

Hopefully they work.

Thanks Stryker.

Both articles are Open Access, so you can click on the link and print the article to take to your orthopedist.

I first began using non-crosslinked decellularized porcine jejunum (small intestine) matrix in the early 2000's for pelvic floor repairs and had great results with it. I had no complications and believed that I got better repairs with the non-crosslinked decellularized collagen matrix, which provided a scaffold for pelvic floor repairs, than native tissue repairs or the synthetic graphs which other doctors were using. In the animal studies of the product that I used, the tritium-labeled (³H) matrix was detectable at 1% in the extirpated organ at 12 weeks. This scaffolding was removed proverbially "brick by brick" and replaced immediately with the desired tissue. It appears that this is what is happening in the ACL. I notice that the hamstring length seems longer at the 2 year follow up. This surgery makes sense to me as an improvement and may be state of the art in about 5 years. (I expect to see Dr Murray https://www.childrenshospital.org/directory/martha-murray on the lecture circuit and national television, when she  is comfortable to promote this.)

In my case, the company pulled the product from the market when the FDA sent warnings about "Mesh" for pelvic floor repairs. Even tho' this was not a mesh, they did not want to hassle with the trial lawyers who would lump this product in with the "meshes", much to my dismay.

By the way, the husband of one of my patients, who had one of my early repairs, went to the Masters in Augusta GA 6 months later and bought me a shirt. That and a few other early patients convinced me the scaffolding did with respect to the repair what meshes or other crosslinked biologics could not do. I still see a few of my repairs 15-20 years later.

[Gregory Sager]

I’ll try to repost the  links to the studies are below:

https://pubmed.ncbi.nlm.nih.gov/27900338/

 https://pubmed.ncbi.nlm.nih.gov/30923725/

Hopefully they work.

Thanks Stryker.

Both articles are Open Access, so you can click on the link and print the article to take to your orthopedist.

I first began using non-crosslinked decellularized porcine jejunum (small intestine) matrix in the early 2000's for pelvic floor repairs and had great results with it.

Translated into Texan as, "Ma'am, let's jus' boil us up some chitlins and we'll use it to fix up your lady parts good and proper!"

(Seriously, though, Ralph, this is impressive work, and I learned a ton about modern surgical replacement techniques for ligaments in your response. Thanks!)

In my case, the company pulled the product from the market when the FDA sent warnings about "Mesh" for pelvic floor repairs. Even tho' this was not a mesh, they did not want to hassle with the trial lawyers who would lump this product in with the "meshes", much to my dismay.

By the way, the husband of one of my patients, who had one of my early repairs, went to the Masters in Augusta GA 6 months later and bought me a shirt. That and a few other early patients convinced me the scaffolding did with respect to the repair what meshes or other crosslinked biologics could not do. I still see a few of my repairs 15-20 years later.

Y'know, I never thought of it this way before, Ralph, but it occurs to me that a lot of the perquisites that come with your chosen profession must consist of tangible rewards from grateful husbands.

[Ralph Turner]

Proverbially, it is extremely gratifying to give a woman back her life with pelvic floor reconstruction. I have the most wonderful patients in the world. I am so grateful for them.