Game-Changing Advancements In ACL Reconstruction: What Athletes Need To Know

Athletes And The Race For Better ACL Reconstruction Options

For athletes in high-contact sports, an anterior cruciate ligament (ACL) tear is a severe injury. This ligament is vital for knee stability, shock absorption, and limiting excessive forward movement. Suffering a rupture can mean several months on the sidelines. ACL reconstruction is the chosen treatment option to allow athletes to return to activity. Traditional open surgery is effective but comes with multiple limitations. Doctors and athletes are seeking game-changing advancements to make the process faster with fewer complications. Options are available to athletes based on severity, health, and accessibility.

How is ACL reconstruction performed?

Traditional open surgery is a common technique used by surgeons to repair the ligament. An incision several inches long is made at the front of the knee. The surgeon will then remove the damaged ligament. A replacement tendon is acquired from a donor or the patient’s hamstring, iliotibial band (IT), or quadriceps. The new ligament is then installed through small holes in the shin and thigh bones and secured with screws. Over several months, the graft integrates into the tunnel. Today, most ACL procedures are performed using minimally invasive surgery (MIS) with multiple keyhole incisions. Small surgical tools, including an arthroscope, help surgeons perform the surgery, limiting tissue damage and complications.

The limitations of traditional ACL reconstruction

While traditional ACL reconstruction is effective, there are challenges, especially for athletes. The procedure requires an extensive recovery period due to the open incision. The patient also needs additional recovery time for harvested grafts. The surgery has a risk of bleeding, infections, and graft site complications. Sometimes, the graft can fail, leading to poor function and additional procedures. Some patients also prefer to avoid the large, unpleasant scar. Minimally invasive surgery reduces many of these downsides but can still require extensive rehabilitation and downtime. The doctor and patient will discuss these limitations before proceeding with surgery.

The rise of regenerative medicine

One of the many advancements in ACL reconstruction involves limiting surgery or seeking natural healing options. Regenerative medicine, which uses the natural healing factors found in stem cells or platelets, is growing in popularity. Stem cells are considered the base material of all tissue and organs. Regenerative medicine places additional stem cells at the knee. By extracting stem cells from bone marrow in the hip, the medical team can inject the sample to promote healing and regeneration. Platelet-rich plasma (PRP) is another strategy to lower inflammation and pain while speeding up healing. Patients often require multiple sessions to see results. Patients with partial ACL tears are the best candidates for regenerative medicine.

Don’t run from the BEAR

A bridge-enhanced ACL repair (BEAR) seeks to repair the damaged ACL instead of using a graft. The BEAR procedure uses an implant to help heal and restore the ACL. This implant is a small, scaffold-like tube made of a unique collagen composite. Collagen is the building block of ligaments, cartilage, and other forms of tissue. The surgical team prepares the BEAR implant and then installs the device with sutures and surgical buttons. The sutures are passed through the implant and fastened to the ACL via the nearby bones. Over time, the collagen implant is absorbed, helping to regenerate new blood cells and tissue. This technique requires a skilled surgeon and is growing in popularity as a way to maintain the native ligament.

Single vs. double reconstruction

The ACL is made of 2 major bundles of fibers known as the anteromedial and posterolateral bundles. During ACL reconstruction, some surgeons may suggest a single or double-bundle approach. The single bundle approach replaces only the anterior fibers. This option is ideal for younger patients with a partial tear. A single bundle procedure shortens recovery, reduces complications, and facilitates a natural ACL. The double bundle approach replaces the anterior and posterior bundles of the ACL. This strategy allows for a stronger replacement but may need additional downtime.

Other game-changing advancements

Surgeons and scientists are exploring the use of robotic-arm-assisted procedures. These devices are popular in joint replacements but can also be used for ACL reconstruction. Robotic-arm-assisted procedures are known for improving accuracy and efficiency, and lowering complications. There is also evidence that tailored rehabilitation plans can help ACL tears heal without surgery. Bracing and stabilizing the knee early and then performing physical therapy (PT) can encourage tears to heal. This allows the athlete to return to sports sooner. Additional strategies like PRP injections can help with pain management and healing.

A bright future in ACL reconstruction

There are now different ways to address an ACL tear. The ideal option depends on numerous factors. Age, patient health, the severity of the injury, and accessibility to innovative treatment all matter. New strategies consist of avoiding surgery or using regenerative medicine. New surgical techniques limit damage while accelerating the recovery time. Discuss the pros and cons with an orthopedic surgeon and make the choice that allows the fastest return to sports.