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Who Will Respond to an ACL Stem Cell Procedure?

POSTED ON IN ACL Procedure Outcomes Knee Latest News BY Chris Centeno

ACL stem cell procedure

This weekend, I’ve spent hours and hours poring over more than 50 before and after MRIs from patients who have received the ACL stem cell procedure we invented. This is the world’s largest collection of data to date on what happens when stem cells are precisely injected into ACL tears. I took a few of those images and crafted the collage you see above out of some of the before shots where patients got complete healing of their torn ACL. Why review all of these images? To find out who might fail this procedure and why.

Healing ACL Tears with Precise Stem Cell Injections

First, ACL surgery is invasive and doesn’t result in anything like the original equipment being replaced. While most patients believe that getting their ACL surgery means a new knee with a new ACL where the old one used to be, what they really get is a bunch of holes drilled in the bone and a tendon put in at the wrong angle to replace the torn ligament. This results in everything from high retear rates to poor position sense in the knee to an earlier onset of arthritis.

Way back in 2011, I thought about whether it would be possible to use imaging to precisely inject the patient’s stem cells into a partial ACL tear. After all, this could save the original ACL. After trying various methods, it turned out to be surprisingly difficult to accurately perform this injection. However, by 2012 we had begun to get it dialed in, and by 2015 we had it, for the most part, perfected. We published a small pilot study on ACL stem cell injections a few years back and have now submitted a bigger study for publication. We also continue to recruit for a randomized controlled trial.

One of the more amazing things is that despite the evolution of this ACL stem cell procedure, the retear and failure rates have been surprisingly small, much less than 10%. Initially, that was because we only tackled easily treated tears (partial ones), but as time wore on, we began treating bigger and bigger tears. However, when the novelty of seeing these tears heal on MRI wears off, it’s time to buckle down to let the data tell us who is and who isn’t a candidate for our ACL stem cell procedure. Hence, this weekend’s MRI fest.

Offset and Other Measurements

About two years ago on Linkedin, a smart radiologist mentioned that we might want to start measuring the offset of the femur relative to the tibia and that this could be helpful in looking at candidates for our procedure. The idea was that since the ACL prevented the tibia from moving forward on the femur, the more trashed ligaments, despite what they looked like on MRI, would allow more movement. This measurement would, therefore, help to quantify more damaged ligaments that might not respond. In general, these measurements seemed to work well, but confirmation bias is an interesting research gremlin. Meaning that thinking you know what’s happening without looking at the objective data can get you in trouble.

This weekend, while measuring each and every one of these MRIs, I noted that some of our successes had awfully big offset measurements, kind of putting a hole in my theory that these measurements were the sole key to defining candidates. While I was able to use some ratios that compensated for the fact that 7 mm of offset in a small woman’s knee was different from the same offset in a large man’s knee, there needed to be another parameter to create a model that could accurately predict patients who were highly likely to fail the therapy.

Morphology or How the ACL Looks

One of the things that became clear from my ACL MRI review was that how the ACL looks may be just as important for predicting who will respond to an ACL stem cell treatment as the offset. Thankfully, I was able to identify some configurations of the ACL that just aren’t compatible with a ligament that will heal.

Creating a Decision Matrix for Our Regenexx Providers

This next month, we’ll begin introducing our providers to a new decision tool that will help them predict if a patient is a good candidate for an ACL stem cell procedure. That tool will also be collecting data to grow smarter as the years progress. The goal is to continue to collect data so that after thousands of ACLs have been treated, Regenexx providers can predict with the highest accuracy possible who will respond and who should be told to skip the procedure.

The upshot? While experienced stem cell providers may have treated a handful of ACL tears with stem cells and consider everyone a candidate for this new procedure we pioneered, at Regenexx we’re moving beyond that into the next phase in any treatment—candidacy. Our new ACL stem cell procedure decision tool will be based on the world’s largest data set of successful and not-so-successful ACL procedures. It will grow smarter and smarter, allowing Regenexx providers to be the only group worldwide with an accurate crystal ball that knows whether you’re a candidate to skip invasive ACL surgery or not.

 

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Joe Hastings says

    Thanks for the great work and continued progress!

    I imagine a lot of candidates will be considering pros/cons of this procedure compared to reconstruction surgery. Do you have statistics on the ("<10%") failure cases such as the length of time to failure and whether or not the candidate then had reconstruction surgery?

    In particular I imagine a lot of people will try this procedure with the plan that if it failed they would then have reconstruction surgery. If they made that decision in say 3-6 mos they honestly wouldn't be that far behind the conventional route (ignoring the flaws of reconstruction and assuming a typical surgical result) but if this took more like 12-18mos it'd be a different experience with potentially a loss of 1-2 years of athletics (again assuming a typical surgical result and ignoring all the complications and negatives of reconstruction). Your "<10%" failure rate is amazing and I don't mean to focus on the negatives but I am curious if you could say anything about the breakdown of those poor outcomes?

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    Chris Centeno says

    Joe,
    Objectively, ten percent failure rate is amazing when compared to surgery, and to the issues that result from ACL surgery, like high re-tear rates, poor position sense in the knee and an earlier onset of arthritis. For an athlete given the success rate and drastically shortened return to play, these procedures can be career savers. Please see: https://www.regenexx.com/acl-surgery-return-to-play/ and https://www.regenexx.com/acl-surgery-return-to-sports/ https://www.regenexx.com/long-term-effects-of-acl-reconstruction-surgery/ and https://www.regenexx.com/another-perc-aclr-procedure-sucesss-acl-tears-stem-cells/ and https://www.regenexx.com/acl-tear-surgery-or-not/ and https://www.regenexx.com/nfl-acl-surgery-2/ Lots more in the blog section....

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    Nancy Thorne says

    Dr. Centeno.
    Dr Handelman fixed both my meniscus and ACL tears 15 months ago. I am now about 80% back to "normal".....but at 65 years old this new normal is fine.
    Thank you, Nancy Thorne

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    Chris Centeno says

    Nancy,
    Great news! We'll share with Dr. Handleman.

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    Marsha says

    Hi, Nancy. Can you tell me, was this done in the U.S., or in the Cayman's? That may make a difference in success, and I'm in the process of deciding whether to have my meniscus tears done in Arizona, or just abandon the possibility, since I know I can't afford the Cayman Islands procedure. I'm 65 also. Any suggestions you can give me? I'm really tired of walking around with this crutch :-)
    Thanks, Marsha

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    Chris Centeno says

    Marsha,
    Dr. Handleman was not performing procedures in Grand Cayman 15 months ago, so it would have been in California.

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    Marsha says

    Dear Dr. Centeno and Regenexx,
    I cannot thank you enough for your diligence in pursuing treatment for these critical issues. It makes such a difference in a person's quality of life, and until I tore my meniscus, I had no idea, and took my health and mobility so much for granted. The work you do is so important.
    Thanks, Marsha

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    Chris Centeno says

    Thanks Marsha!

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    Tricia Michel says

    Dear Dr Centerno,

    Will receiving a stem cell treatment during ACL surgery speed my recovery time? I was not a candidate for Stem Cell alone as my ACL is completely torn.

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    Chris Centeno says

    Tricia,
    It may help the graft adhere to the bone tunnels. Have you been evaluated for a Regenexx ACL procedure?

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    Peter Hunt says

    Which type of MRI image do you need, DICOM or just JPEG?

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    Chris Centeno says

    Peter,
    Once you submit the Candidate form, you'll receive an invite and instructions on how to share your MRI images.The Doctor will need the entire series.

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    Foram says

    I have meniscus tear in knee, plz guide which treatment gives better n faster result : surgery or stem cells or surgery+stem cells? what are the side effects and success rate? By proffesion I am a dancer and so I want to know whether i can get back to my profession or not?

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    Chris Centeno says

    Foram,
    Meniscus surgery is a net negative for everyone, but even more for someone who puts the type of demands a dancer puts on knees. Meniscus surgery does not repair the Meniscus, it removes sections of it, leaving the knee cartilage exposed to unnecessary wear and tear, and leaving the knee unstable. Whereas as using your own stem cells actually repairs the tear, keeping the biomechanics of the knee healthy. Please see: https://www.regenexx.com/should-i-get-meniscus-surgery/ and https://www.regenexx.com/meniscus-tears/ and https://www.regenexx.com/does-meniscus-repair-work/ To see if you'd be a candidate, please submit the Candidate form.

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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