May 2, 2017
What’s new in ACL reconstructions?
Today’s preferred surgical method for treating ACL knee injuries is still the reconstruction method using substitute graft tissue.
However, an old procedure known as an ACL repair is trying to make a comeback!
ACL tears are often treated surgically in sports-minded individuals. The older method of an “ACL repair” is suturing the two torn tendon ends together. This is a relatively easy arthroscopic operation and was the procedure of choice in the 1980’s. Due to poor outcomes of ACL repairs, the reconstruction method has become the gold standard for ACL injury treatment. In a reconstruction, the torn ACL is remade with an alternative piece of tissue (the graft) which provides immediate strength and security to the knee. When comparing ACL repair and ACL reconstruction the repair method has always proved to be inferior in terms of predictably stabilizing the knee. The ACL repair method also requires a prolonged recovery period. So the ACL reconstruction remains the superior procedure.
The ACL repair method has been revisited and new clinical studies are being conducted. New advances using internal bracing sutures to assist with early stability have been used. In other clinical studies, researchers are using special proteins and stem cells to improve the outcomes of traditional ACL repairs. One study (the BEAR procedure) inserts a sponge infused with growth factors that may help the ACL fibers heal. These new clinical studies are promising.
Bottom Line
The ACL repair has promise but remains clinically unproven. (Beware of medical marketing that says otherwise). The long-term outcomes of ACL repair procedures in the past were poor. The outcomes of newer ACL repair procedures are still unknown. In fact, we won’t know the results until athletes have returned to sports with their ACL-repaired knee for several years. Children with open growth plates may be the best candidates for this procedure in the early going. The failure rate of this procedure is likely to be significant until more technologically advanced scaffolds are developed. At this time, the most predictable and successful ACL procedure is, by far, the ACL reconstruction.
ACL Reconstruction
ACL Repair
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