Revolutionizing the ACL Surgery

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ACL tears are devastating injuries that take athletes out of the sports they love for up to 12 months at a time. A large reason this injury is so difficult to recover from is because the surgery that is required to fix it is invasive and involves damaging another part of your body, or introducing a foreign body into your leg, which can take a prolonged time for your body to fully accept. Dr. Martha Murray, of the Division of Sports Medicine and The Micheli Center,  and Dr. Lyle J. Micheli have been working on a way to revolutionize ACL repair surgeries that will eliminate the need for either of these options.  We recently took the time to find out more about this scientific breakthrough from Dr. Murray.

Q: What is the difference between the new method you and Dr. Micheli are studying and the current method for repairing ACL tears?

A: The traditional surgery for a patient with an ACL tear involves removing the torn ACL and replacing it with a graft of tendon, usually taken from somewhere else in your knee or thigh.  This is called an ACL reconstruction.

“Bridge-Enhanced ACL Repair” involves keeping the torn ends of the ACL, and instead of replacing them with a tendon graft, the ligament is repaired with stitches.  As part of the repair, a sponge is placed between the two torn ends of the ligament and a tablespoonful of the patient’s blood is placed onto the sponge.  The sponge absorbs the blood and holds it in place for several weeks.  The blood acts as a stimulus for healing of the ligament (the same way it does when you get a cut in your skin and a scab forms or when you get a broken bone and the blood helps that heal).  The sponge prevents the blood from being washed away too quickly by the fluid in the knee joint and keeps the blood in place long enough for the ACL to heal back together.  This is a brand new procedure, now being tried for the first time in patients.

ACL Illustration

 

 

 

 
Q: What is the difference in recovery for athletes?

A: We don’t know yet as we are only just starting to study this in patients.  We are hoping that because we don’t have to take a graft from elsewhere in the knee, that the recovery from the ACL repair will be easier, but we need to study this to see if that is true.
Q: Are you expecting long term differences, could this extend athlete’s careers?

A: When we studied this technique in pig knees, the “Bridge-Enhanced ACL repair” technique resulted in a healed ACL which was about as strong as an ACL graft at 3, 6 and 12 months after surgery.  However, the pigs treated with the bridge-enhanced ACL repair had less arthritis than those treated with an ACL graft.  However, we do not know if these same results will be true in human knees as well.

Q: When could this be “available to the public”?

A: There is still a long road to go.  We need to first see how the patients in this first-in-human study are doing.  Once we are sure they are doing well, we would need to obtain FDA approval to conduct a larger clinical trial.  This trial would generate data needed for both the FDA (who have the final say in when this device can be used and in whom) and for insurance companies (who have the final say in whether patients could have insurance coverage for a new procedure like this).  Even if everything goes perfectly, we would need to raise funds, and then design and perform these larger clinical trials, and finally collect and present the data and obtain the necessary approvals.  We will be working as hard as we can to make this go as smoothly as possible, but we also want to make sure at every step we are getting all the details right and making this new procedure as safe and effective as possible for all of our patients.

Q: How can I find out more information about “Bridge-Enhanced ACL Repair” or possibly participate in these early studies?

A: This technique is only available for a limited time at Boston Children’s Hospital, and at this time is only open for patients ages 18 to 35 with a recent ACL injury (less than one month old) and no prior significant injury to the knee who are able to come to Boston Children’s Hospital (Boston and/or Waltham locations).  If you are interested in possibly participating in this early study of “Bridge-Enhanced ACL Repair”, please contact bear.trial@childrens.harvard.edu.

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