An anterior cruciate ligament (ACL) injury often means that you feel your knee giving out. A “popping” noise may also be heard, and there may be pain along the outside or back of knee. Partial ACL tears may “heal” on their own, but other problems can develop down the road because of incomplete healing and other associated injuries. Complete healing and repair of the entire injury is important, and comprehensive Regenerative Orthopedics are effective treatment options for ACL injuries.
Repair of the anterior cruciate ligament (ACL) has traditionally been surgical, but an increase in injuries has lead to a higher need of repair and an increase in younger patients who may end up with complications with these surgical repairs. Because of these changes, alternatives to surgery are being sought. Regenerative techniques are being considered because they enhance repair and regeneration of tissue and are excellent options specific to the repair of ligament and tendon soft tissue structures.
Why is ACL repair important? Because the knee instability that occurs due to injury needs to be resolved, or further damage can occur to the other knee structures. Without resolution of the instability, the long-term complication of arthritis will also likely occur. Additionally, regenerating the injured ligament, rather than replacing it with grafts, can help boost the normal biomechanics of the knee. (1)
The ACL responds well to healing by regenerative treatments like Platelet Rich Plasma, which provide the needed fibrin-platelet clot and growth factors for repair. PRP is a rich source of growth factors, limiting inflammation, and promoting tissue regeneration. (2) This platelet concentrate releases a number of crucial growth factors that stimulate repair and collagen production.(3)
Regenerative Orthopedics are an effective alternative for the difficult-to-treat younger patient with ACL injury. Researchers in the Sports medicine and arthroscopy Review say this:
“Younger and more active patients benefit from regenerative approaches that encourage biological repair since they prevent complications provoked by the high stresses due to high physical demand over a prolonged time after classic replacement with synthetic materials.”(3)
At our OrthoRegen® clinic, patients are looking to avoid surgery, or have tried surgery and continue to have knee issues. Many young athletes choose surgery because they expect it to get that back in the game. Sometimes it does and sometimes it fails. Physical Therapy also works to strengthen the leg, but unfortunately may not work to sufficiently stabilize the knee, because the ligament cannot be repaired with PT. Therefore, a non-surgical solution to repair the instability is desired.
Additionally, when an injury is significant enough to injure the ACL, it is very likely that other knee ligaments and/or the meniscus are injured as well. That’s when comprehensive regenerative treatments really shine. Why is that? Because comprehensive Regenerative Orthopedics treat the entire knee. All of the injured areas will be attended to for maximal healing results. On the other hand, ligament reconstruction, the usual management technique for significant ACL injuries, using replacement auto- or allografts, as noted earlier, have less than satisfactory outcomes, including instability that could progressively damage other knee structures, and result in arthritis.
A November 2021 study in the Progress in Rehabilitation Medicine investigated whether student-athletes with anterior cruciate ligament (ACL) injuries who returned to sports without reconstruction could continue their sporting activities until the end of the season and whether there was an increase in secondary damage associated with knee instability. What did they find? The majority of athletes experienced their knees giving way and some experienced injury of their meniscus. Unfortunately, with ACL injury, instability occurs and the knee needs to be repaired. Non-surgical repair with Regenerative Orthopedics is an effective option.
Here’s what researchers from Brown University say, “Accelerated rehabilitation has made recovery from (ACL) surgery more predictable and shortened the timeline for return to play (from ACL reconstruction surgery). (However) Despite success with advancements in anterior cruciate ligament reconstructions, some athletes still fail to return to play.” There may be short-term results, but in the long-term, stability of the knee becomes problematic. A solution that saves the biological ligament, like Regenerative Orthopedics is able to do, is the optimal way to go, because it repairs the underlying problem of instability and treats the whole knee, including the meniscus. (4)
Instability of the knee after ACL injury or even ACL surgery will lead to the eventual breakdown of the knee structures. The instability needs to be addressed. The abnormal motion that is caused by the ACL injury needs to be repaired to stop secondary pathology from the instability. Knee instability is the problem that needs to be solved, and no amount of surgery will address it. Regenerative Orthopedics do address knee instability.
Prolotherapy, one type of regenerative therapy, has been around a very long time. The treatment has long been associated with being effectiveness in treating joint instability due to ligament and/or damage. Over the years, research continues to prove its efficacy as a non-surgical treatment for joint and spine pain and injury. (5)
We also mentioned the research on the benefits of PRP earlier. That study and others, show the benefits of biological augmentation, using PRP and stem cells, to improve healing and a faster return to sport and activities of daily living for those with partial ACL tears. (6)
It is important to note that if the tear is complete, these regenerative therapies cannot regrow an absent ligament. They can restore strength and stability for a partial tear, ACL damage, and other knee soft tissue injury. Additionally, for the highest success, the entire knee should be addressed and treated comprehensively in order to repair all damaged structures and prevent the development of arthritis.
Depending on the severity of injury, Prolotherapy alone may be recommended. If meniscus injury is present, Prolotherapy and PRP may be recommended. And, if more advanced degeneration and/or arthritis is evident, stem cell treatment may also be indicated.
Has surgery has been recommended for an ACL repair? Are you are seeking a non-surgical solution for an ACL injury? If so, we would be happy to discuss our Regenerative Orthopedic approaches and your options for ACL tear repair.
(1) Vavken P, Murray MM. Translational Studies in ACL repair. Tissue Eng Part A. 2009
(2) El-Sharkawy H, Kantarci A, Deady J, et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78:661–669.
(3) Vavken, Patrick, and Martha M. Murray. “The potential for primary repair of the ACL.” Sports medicine and arthroscopy review 19.1 (2011): 44.
(4) Morris RC, Hulstyn MJ, Fleming BC, Owens BD, Fadale PD. Return to Play Following Anterior Cruciate Ligament Reconstruction. Clin Sports Med. 2016 Oct;35(4):655-68. doi: 10.1016/j.csm.2016.05.009. Epub 2016 Jun 22. PMID: 27543405.
(5) Reeves KD, Hassanein KM. Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity. Altern Ther Health Med. 2003 May-Jun;9(3):58-62. PMID: 12776476.
(6) Dallo I, Chahla J, Mitchell JJ, Pascual-Garrido C, Feagin JA, LaPrade RF. Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review. Orthop J Sports Med. 2017 Jan 25;5(1):2325967116681724. doi: 10.1177/2325967116681724. PMID: 28210653; PMCID: PMC5298533.