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Avoiding surgery for an anterior cruciate ligament (ACL) tear should be a top priority in 2017. Why? We’re on the brink of a dramatic change in how we treat these injuries and, literally, getting surgery for this problem could put you in the “old technology” group. How dramatic will this change be? Most surgeries are about to go away altogether, instead being replaced by a precise injection into the ligament.

The Perc-ACLR Procedure

We invented orthopedic stem cell injections, and, likewise, we’ve invented other procedures as well that were never contemplated before. We spent years figuring out the techniques needed to effectively inject all parts of the ACL. We call this a perc-ACLR procedure which stands for percutaneous ACL repair procedure.

Right now, when we inject high-dose bone marrow stem cells into the right patients and into the right spots using C-arm fluoroscopy, about 70% of the patients who would currently be offered surgery don’t need the procedure. In addition, we see good evidence of healing in the ligament on postinjection MRIs. Hence, you can see why this procedure could be the game changer that makes most ACL surgery obsolete.

Why Would You Want to Avoid Surgery?

So why would you want to avoid invasive ACL surgery and consider the nonsurgical perc-ACLR procedure? Research has shown that ACL surgery doesn’t prevent arthritis and is ineffective. In athlete patients, for example, those who didn’t have ACL surgery are more able to return to sports after one year than those who did have the surgery. These alone may be good reasons to avoid surgery; however, there are many more:

• Reconstructing the ACL often leaves the joint rotationally unstable.
• The knee is never quite the same after ACL surgery with the loss of both position sense and performance.
• There’s an increased risk of tearing the other ACL or retearing the operated-on ACL after surgery.
• Two-thirds of teens who undergo ACL surgery will develop arthritis by age 30.
• Eight months following ACL surgery, less than 1 in 5 athletes are able to return to play.
• ACL surgery shortens professional athletes’ careers.

Anna’s Story

Anna is an active mother of four-years-old twins. Having had four-year-old twins at one point, I understand that when you’re alone with them, the best you can do is to play “zone coverage” as “man to man” is out the window. So active is an understatement.

This 40-year-old tore her ACL playing volleyball. With four-year-old twins, she didn’t feel like she could take the time to undergo surgery. Being laid up on crutches or not able to move quickly for weeks, ha! Anyone who has been a mom of young and mobile twins knows how unrealistic that scenario looks. Hence, she opted for our perc-ACLR procedure as it had much less downtime.

The image on the left shows a completely blown-out ACL. What’s left of the ligament is shown inside the yellow arrow heads. In fact, there are so few organized fibers left that we didn’t think this patient was a good candidate for this procedure, but she really wanted to avoid surgery, so we let her proceed. The image on the right shows the six-month follow-up. The much more normal-appearing ACL is inside the green arrow heads. She’s also doing well as far far as pain and function and is back to all activities.

The upshot? This is one of the more amazing results we’ve seen comparing the before and after MRIs. However, realize that to get these results, you must have a physician who has been trained to precisely inject the high-dose stem cells into the ACL. This cannot be done well using ultrasound and requires fluoroscopy to be done correctly every time. The only training in existence right now is through the Interventional Orthopedics Foundation. So if someone tells you they can do this injection without having gone through that testing, it will be hit or miss if they can produce this kind of result.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile