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ACL *repair* experiences ("internal brace")

 Poster: A snowHead
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Hi, has anyone on here had the "internal brace" treatment to repair (not replace) an ACL? I've been looking into it and wondered how people are faring a few years after having it. It seems to be relatively new technique and it would be good to get some information on the longer term outlook of the treatment. I believe it was invented by Gordon Mackay who has done a reasonable number of these ops and it's becoming increasingly popular. The idea is that you basically thread a kevlar (?) tape through the ACL and the ACL regrows and rejoins along it though there is uncertainty as to whether the new ACL actually bears any load or if it is actually the tape that performs the load-bearing function of the ACL. I do like the idea of a quicker recovery period and not having to give up some hamstrings as I would in an ACL replacement.

Cheers!
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Hi @aclbroke, welcome to Snowheads - even if not in the best circumstances...

There was some discussion about this a while ago: http://snowheads.com/ski-forum/viewtopic.php?p=2853048

Probably particularly worth reading the comments by Jonathan Bell
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Thanks. Sad

I saw that thread and am hoping Ksenia will get back to me about their progress. It is really a longer term question though i.e. 30+ years.
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@aclbroke, I can't comment on the internal brace, but my experience of a hammy graft has been nothing but positive. Yes, the initial 6-8 weeks are a pain in @rse (and knee), but after that I actually enjoyed the rehab. It got me back down the gym, I lost a bunch of weight I'd been meaning to lose for years and my legs became much stronger. I was skiing 9 months after the op, with a CTi OTS knee brace, and after a nervous couple of runs it was all good. The op leg got tired initially, but that soon goes away. I had a few 121 lessons, giving knee history, and was given lots of exercises, drill and advise based on the specific issue and recovery. As a result I'm a much better skier, and slimmer & fitter (reports that I'm better looking and more amusing are perhaps less reliable).

I'm not suggesting snapping an ACL as a training method, but it doesn't have to be all doom and gloom.
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Quote:

I was skiing 9 months after the op, with a CTi OTS knee brace


Hi Dr John, I ruptured my ACL + meniscus tear last September playing football (age forty-something) Sad and could have had the op this month (Feb'17) but have put it back until after my ski trip in April.
Lots of work in the gym several times a week at the moment hoping to be strong enough in the quads and hams to take part at a leisurely pace - my consultant says I'll be ok wearing a brace and no crazy skiing (damn Toofy Grin ).
So I'm on the lookout for brace recommendations, hence why I'm on here. Consultant recommended a Bauerfeind Softec Genu, retailing at £499 - no thanks.

I've seen a Ossur CTi OTS on eBay for half that - so would you recommend?

Been looking at Donjoy braces too (4titude and FullForce). Any other recommendations by anyone?
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@Gilbern74, I have used an Ossur custom for a while. They are custom made so not sure there is any benefit in buying one second hand. What if the seller is a different build to you? You will end up slopping around in it or being uncomfortably tight. They are intended to prevent hyper extension and must have sufficiently good grip on both your thigh and shin to prevent this. Even with the brace I have had a case of tibial plateau bruising from hyper extension so I would say they are not a catch all. But, like all safety equipment I will probably continue to use it as who knows what might have happened if I hadn't?

This is not a thread about external braces. That has been done many times previously, but if you go down the brace route is your knee not worth a few hundred pounds to protect?
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@aclbroke, ksenia did post an update on another thread earlier this year:
http://snowheads.com/ski-forum/viewtopic.php?p=2995121&highlight=#2995121
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aclbroke wrote:
Hi, has anyone on here had the "internal brace" treatment to repair (not replace) an ACL? I've been looking into it and wondered how people are faring a few years after having it. It seems to be relatively new technique and it would be good to get some information on the longer term outlook of the treatment. I believe it was invented by Gordon Mackay who has done a reasonable number of these ops and it's becoming increasingly popular. The idea is that you basically thread a kevlar (?) tape through the ACL and the ACL regrows and rejoins along it though there is uncertainty as to whether the new ACL actually bears any load or if it is actually the tape that performs the load-bearing function of the ACL. I do like the idea of a quicker recovery period and not having to give up some hamstrings as I would in an ACL replacement.

Cheers!


There are lessons to be learned from history.

A quick bit of glossary of terms that may be confusing:

i) Repair means to try and save the ligament and stitch it back in place.
ii) Augmentation is to bolster the repair with another cord of material like gortex or some other polymer.
iii) Reconstruction is to remove the ruptured ligament and substitute it either with a graft ( a bit of tendon) or an artificial cord of polymer.

The operation of internal brace is an augmented repair using an artificial ligament.

Right here goes:

Repair of the anterior cruciate ligament (ACL) used to be carried out frequently.

It was abandoned because the results were consistently poor with continued instability.

This has been shown in many long term follow up studies.

There were some studies in 80's and 90's that suggested that repair of the ACL plus augmentation with an artificial ligament could get good results.

The results were mixed and it was abandoned.

At the time alot of artificial ligaments were placed into the knee to deal with ACL rupture.

I've taken out many and when they shred they leave lots of unpleasant debris in the knee which doesn't look good ground into the surface of the articular cartilage..

Recently there has been an attempt to revisit total replacement of the ruptured ligament with an artificial ligament. The results have

been disastrous for many of the patients who were subject to this surgery.

Since that latest round of bad results there has been alot of interest in whether we can, once again, repair the ligament ( Augmenting it with a cord of artificial material) rather than replace it.

You'll notice that this approach is sounding familiar!

Here is a bit more history to consider along side the current approach that is being championed by the "designer" of the internal brace procedure.

One thing is clear and that is that not all ACL ruptures are the same, in particular the site of injury and the extent to which it involves both bundles of the ligament.

One author some time ago looked at a series of repairs and concluded that a clean detachment off the femur was the pattern that does best with repair.

This pattern of tear accounted for 22% of all the injuries. So how do you identify which will do well, it looks almost certain that it will be very few?

MRI doesn't help because it isn't that reliable in identifying the injury let alone detailing the site and extent of damage.

In other words it will be extremely difficult, if not impossible to identify which ligaments may be worth repairing, but it should be a small minority.

One of the suggestions why repair didn't work in other patterns of tear was that the damaged ligament

ends up quite frayed at the ruptured end and that when attempting to reattach it it is a bit too short thus resulting in a gap. The BEAR technique

( currently being developed in Boston) attempts to deal with this by filling the gap. We wait to see if it works, so far there is no proof you can bridge the gap.

Rob La Prade shares this view http://drrobertlaprademd.com/dr-laprade-comments-dr-murray-new-bear-acl-repair-technique/.



Do remember there are no published results ( other than anecdotal report) demonstrating the success of this operation nor that the recovery is any quicker.

We may learn who could benefit from this operation and whether it works as more results get published but that is not clear at the moment.

Finally the claims that recovery will be quicker are unsubstantiated.

Recovery from ACL surgery is limited initially by swelling in the knee then by the steady recovery of neuromuscular function. If anything the current thinking is that we

have been trying to get patients back too soon and are not completing a full neuromuscular recovery program. Its for that reason i started the Return to ski program that few SH have been on.

I also now now have my own physio in every follow up appointment to help me judge recovery and i've found that i have slowed recover programs down to accommodate the time need to regain strength etc.

Finally don't forget that not everyone should have an ACL reconstruction as it may be required.

Jonathan Bell
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@Gilbern74, I'd recommend it because it worked for me, haven't tried any other. I had mine fitted by a physio (on strong recommendation from surgeon) who also advised on best use. Weaned myself off it after 2-3 years (about 7 weeks skiing), & now don't even think about it, apart from a slight ache in the afternoons, which is easily dealt with by slope-side self-medication.
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Please could we try to keep this on topic. I am not talking about any external brace that you strap over your leg. I am talking about a relatively new surgical procedure.

Thanks @Dr John, for the encouragement. The more positivity I get, the better on this. It's good to hear that the future is not bleak. It's just the decision making is quite hard on which procedure to get.

I value your input greatly @Jonathan Bell. I've been doing a lot of reading (too much?!) and the failed carbon fibre ligaments of the 80s are certainly at the back of my mind. There has been a 1 year study where the success rate of the internal brace is similar to the ACL replacement. This is a link to the recent report on it which makes interesting reading:
http://www.mackayclinic.co.uk/wp-content/uploads/2016/12/ACL-repair-revisiteduse.pdf

The BEAR link is interesting and the more innovation on this the better.

Obviously I'm in this for a lot more than 1 year so I'm trying to weigh things up. Biggest concern is, what are the long term chances of the reinforcing tape failing and if it does fail can the healed ACL bear the load all by itself? Also, would the tape failure create a problem in the body akin to the carbon fibre failed ligaments and would you be able to detect the failure of the tape? If I can reconcile these things in my head I would be happy to try the new technique.

(Edited to fix a mix up with doctors' name)
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One year isn't enough
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My son, who is 20, had ACL and ALL repair last Tuesday (6 days ago) using the internal brace technique.

Early days but he can currently extend the knee fully and bend it more than 90 degrees. He is using crutches but can put some weight on it without pain. Since yesterday he has not needed to take any painkillers.

Hospital physio told him that because he doesn't need to protect his hamstrings (since no graft required) his rehab should be easier. He starts rehab physio this week.

Surgeon was Prof. Adrian Wilson of Hampshire Knee. He will only use this technique where he deems it appropriate. The plan, in my sons case, was to use hamstring grafts, but having got into the knee, he decided that he was a perfect candidate for IB repair (this was previously explained and discussed).

I will update with his progress if there's interest here.
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Thanks @Tiredoldskibum. I hope it goes well for your son. I think there is certainly interest in how things go though the ideal would be to meet people who had the repair op 20 years ago but clearly that won't happen with a new treatment.
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@aclbroke,

My understanding is that, when ACL reconstruction/repair was first tried (30 odd years ago in the US), the pioneering surgeon first tried repairing the ligaments rather than rebuilding them. He found that two out of three subsequently failed so he turned his attention to using grafts instead which has become the standard procedure.

Four or five years ago Dr Mackay looked at the process again and started trying repairs. The current procedure, is different to one tried 30 or so years ago in that rather than just stitching the ligament back together, a reinforcing artificial brace is constructed (using FiberTape) around which ligament tissue can eventually regenerate (note, I am in no way medically qualified so I stand to be corrected here).

The same materials and similar techniques are used in other reconstructive orthopaedic surgeries

Much more info here

https://www.arthrex.com/knee/fibertape-and-tigertape


As an aside, I recently spoke with a man who underwent ACL reconstruction using grafts, over 20 years ago and has had to have multiple (I think he said 14) surgeries since. He opted to have the knee joint replaced two years ago and is delighted with the outcome. But he is only in his early 50s now so that artificial joint has to last him a long time. There are no guarantees of anything, all you can do is look at what's on offer, weigh up the advice and choose what you think is best for you.


Last edited by You know it makes sense. on Mon 27-02-17 14:44; edited 4 times in total
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Thanks for the link, I too read this recently. I feel like I've researched this to death now! It is great that the ACL can actually mend with the internal brace + tape.

My main concern is basically about how long the tape lasts and if it fails, is that failure detectable and does it have effects that cause problems in the body, and can the healed ACL take the strain all by itself? Also, the tape is incredibly strong and (as far as I can tell - can't find a datasheet) inelastic unlike the ligaments of the body which have an element of elasticity. Does this difference in behaviour cause a problem long term? ACL research does seem to be going far too slowly so it's good to see new techniques being tried all the same. So many people get this injury. :-/
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Again, my understanding is that the tape stays put forever, but that the regenerated (for want of a better word) ligament provides most of the stability.

As you quite rightly say, there are no long term statistics available for this procedure, but that is true of anything newish. If we resisted all change on that basis we'd still be hunter-gatherers Very Happy

Best of luck to you in whatever you decide to do
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@aclbroke, why not contact Gordon himself to ask those questions? He is pretty approachable.

I didn't have my ACL repaired by him, but I did have the lateral and medial menisci cleaned up in a follow up operation and he was really good with those. (past personal experience is no guarantee of etc etc....)
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aclbroke wrote:

I value your input greatly @Jonathan Bell. I've been doing a lot of reading (too much?!) and the failed carbon fibre ligaments of the 80s are certainly at the back of my mind. There has been a 1 year study where the success rate of the internal brace is similar to the ACL replacement. This is a link to the recent report on it which makes interesting reading:
http://www.mackayclinic.co.uk/wp-content/uploads/2016/12/ACL-repair-revisiteduse.pdf

The BEAR link is interesting and the more innovation on this the better.

Obviously I'm in this for a lot more than 1 year so I'm trying to weigh things up. Biggest concern is, what are the long term chances of the reinforcing tape failing and if it does fail can the healed ACL bear the load all by itself? Also, would the tape failure create a problem in the body akin to the carbon fibre failed ligaments and would you be able to detect the failure of the tape? If I can reconcile these things in my head I would be happy to try the new technique.

(Edited to fix a mix up with doctors' name)

I had my Carbon Fibre implant more than a year after the original study. As the ever kind Mr Bell says - One year is not enough. I could not recommend being a ginuea pig rolling eyes
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Hi, I don't know if this helps but i too looked at the Internal Brace concept long and hard. Who wouldn't want an ACL repaired and back to normal?
I visited the Fortius Clinic in London - home to some pretty top surgeons - and asked about it. The answer was simple " If it was so great, of all the surgeons in the UK, why is only 1 (or 2) using it? Why do you think that is?" Seemed a good point. A lot of these guys really know their stuff and some are brilliant surgeons - why on earth would they not try something if it was great? I walked in prepared to try. It was not as if they even tried to sell me any operation. They didn't - indeed told me to go away, build up muscle and heal the Medial (12-16 weeks) and then see if i could do everything i wanted to do as the knee was stable despite ruptured ACL. So did not have axe to grind. I am sure if they believed it had merit above all else, they would be using - why not? Maybe a different story if you are a pro athlete and the pressure to return to not lose your contract is greater - maybe you don't mind a revision in a couple of years etc. as financial and career dominate the health decision.
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@Sweetpea, welcome to snow snowHead s!
Though sorry to see you join up in this circumstance.

I ruptured my ACL a couple of weeks ago and am pre - op, so shall be reading this thread with great interest.
To be honest, based on what I've read so far, it really seems to be an open - and - shut case.
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Hi Snowglider... thanks and sorry to hear of your injury too.

I had a few opinions on mine over last 4 weeks.. thought i was doing quite well pre-habbing to be honest - had gone from not straight and couldn't bend to what i thought was straight and about 135deg flexion. OK for a couple of surgeons to want to operate. Then i see one of the really top guys... " nowhere near; miles off, 3 degrees difference to other leg is MASSIVE; you massively increase AF risk like this etc etc. Repair medial, build up your strength not just ROM; your ACL is broken in middle but nicely aligned; 40% attach to PCL; your pivot is not positive so you have a better chance doing conservative treatment; life is about risk, see what you cant do first; OA is increased by operation not decreased - those that say otherwise quoting x (one key) paper which had x flaws..."

i.e. if you want a superb result then has to be superb going in is what i am learning.. not just what you think is good & vasty improved - but when they say prehab the top guys really mean 'fitter than you've ever been in your life' and i am an ex-international hockey player.

Surgery seemed to be determined by 4 key things: 1. activity (i.e. football or rugby or tennis (not skiing) 2. Positive pivot test 3. Ongoing Instability 4. If ONLY ACL in isolation. If you dont tick all the boxes, then the top guys wait it seems to me and see if you can build up enough strength to not need it. If you are 30, play footie, have ongoing instability and a pos pivot then clearly a different decision would be made. So my only tip to date would be pay £250 to get a dead hot opinion from those regarded to be right at the top of the tree as its a small sum to pay for total expertise. I've had one surgeon wish to operate immediately; 2 within a month and all had their pet way of doing things. Then i went up to the top of the tree and it was 'none of this is right for you... do this and then see what happens as surgery not indicated when the 4 key things are not met (at least not at current time). I spent a month agonising over decision on what, which, when etc. I then met the top guy who took that out of my hands and told me what to do for my health at the current time, which was not in his favour. Find a guy who doesnt tell you what they do all the time (e.g. i do Internal Brace; I do single anatomical hamstring; I do cadaver etc etc) and find one who can do anything and everything and is more interested in what is best for you is probably where i am at the moment. Top surgeons love to operate so when they send you away and tell you they are not going to operate, probably means more.

Hope these are good tips - i don't know if they are or not really, but seems to be my accumulated knowledge to date!

With respect to Physio, the guy i now have is awesome... e.g. realised i was doing loads more front crawl given cant do much else sportswise so picked up on rotator cuff exercises to make sure i was balancing them equally as was probably favouring one body side given knee etc....
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aclbroke wrote:
Hi, has anyone on here had the "internal brace" treatment to repair (not replace) an ACL? I've been looking into it and wondered how people are faring a few years after having it. It seems to be relatively new technique and it would be good to get some information on the longer term outlook of the treatment. I believe it was invented by Gordon Mackay who has done a reasonable number of these ops and it's becoming increasingly popular. The idea is that you basically thread a kevlar (?) tape through the ACL and the ACL regrows and rejoins along it though there is uncertainty as to whether the new ACL actually bears any load or if it is actually the tape that performs the load-bearing function of the ACL. I do like the idea of a quicker recovery period and not having to give up some hamstrings as I would in an ACL replacement.

Cheers!


Hi there

I created a login to specifically reply to you.

In Jan 2017, I sustained a complete ACL tear and bad MCL tear. After days of in resort research I concluded that out of all the UK ACL surgeons Gordon Mackay was the only man for me. Prof Mackay kindly rearrange his schedule to fit me in for surgery. On return to London, I travelled to Scotland in Feb 2017 to have 2 internal braces fitted (1 X ACL & 1 X MCL). Suitability for the brace can only known when the surgeon sees inside the knee so I wasn't sure what kind of treats I had in store when I woke up.

Thankfully, my ACL injury was suitable for the brace and my MCL didn't require one. I believe that this type of surgery is more successful when carried out on recent injuries.

The recovery was very painful but I'd expect it would be no worse than any other type of ACL surgery.

I'm 5 months into recovery and I've detailed below my current pain & functionality levels for you:-

1. Swimming 60 minute front crawl with tumble turns- 4 times a week - no pain
2. Cycling 60 minute with some resistance- 3 times a week - no pain (could do more but have hamstring issue)
3. Running flat 17 minute- 3 times a week at 10k pace - no pain (could do more but being sensible)
4. 1.30 hour physio- 3 times a week - no pain
5. Leg straight - no pain
6. Quad stretch achieve 95% - minor pain
7. Fully Kneeling on knee achieve approx 75 % - moderate pain
8. Pivot movements - moderate pain

I'm astonished with the speed of my recovery along with the lack of scarring and the level of activity I'm currently able to do.

I don't know if I will be ready mentally for 2018's ski season, however, I'm confident that my knee isn't going anywhere as it feels super strong/stable with this internal brace.

Let me know if you need any more info.

M

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Hi

I am an orthopaedic surgeon in hampshire, and a big skier. I do soft tissue knee reconstruction and do both ACL reconstruction and ACL repair (Arthrex internal brace). They are both excellent means of getting back on track. The main thing allowing you to go down the route of ACL repair is timing. It is something that is possible if you get in early 3-6 weeks. Much later and the window of opportunity has gone. The big difference if you can have it repaired is that we don't need to take your hamstring tendons to make a new ACL. The operation is just a much smaller procedure. The best way I can describe it is like putting a plate on a bone to hold it in position to allow it to heal. We just happen to be using a special piece of nylon tape to support the knee while the torn ACL heals. Also not all ACL reconstructions are the same. If you have one make sure you ask if it is an anatomical reconstruction. Some older consultants still use a traditional (old fashioned!) technique of transtibial, which we now know is not putting the graft where your old one was. They tend not to give as much rotational control of your knee which you need for skiing and football. Let me know if anyone needs any more info. my website is www.wessex-knee.com.
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What Jonathan Bell wrote above is more or less identical to what Dr Jacques Vallotton told me. Swiss expert who treats professional sports people (including skiers) in Lausanne.
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Quote:

Do remember there are no published results ( other than anecdotal report) demonstrating the success of this operation nor that the recovery is any quicker.
We may learn who could benefit from this operation and whether it works as more results get published but that is not clear at the moment.
Finally the claims that recovery will be quicker are unsubstantiated.


http://journals.sagepub.com/doi/abs/10.1177/0363546517717956

Quote:
Methods:
An electronic database search was performed to identify 89 papers describing preclinical and clinical studies on the outcome of ACL repair.

Results:
Proximal ACL tear patterns showed a better healing potential with primary repair than distal or midsubstance tears. Some form of internal bracing increased the success rate of ACL repair. Improvement in the biological characteristics of the repair was obtained by bone marrow access by drilling tunnels or microfracture. Augmentation with platelet-rich plasma was beneficial only in combination with a structural scaffold. Skeletally immature patients had the best outcomes. Acute repair offered improved outcomes with regard to load, stiffness, laxity, and rerupture.

Conclusion:
ACL repair may be a viable option in young patients with acute, proximal ACL tears. The use of internal bracing, biological augmentation, and scaffold tissue may increase the success rate of repair.


There is some evidence coming out regarding the internal brace. The inventor of the internal brace with Arthrex who has the largest group of patients presented his outcome data at a orthopaedic research meeting in Glasgow and the results are impressive. The Internal brace is not an artificial ligament at all, it is there to resist the stress in the knee to allow the repaired ligament to heal, just like a plate on a bone, it is only 2mm wide and contained within the original ACL tissue. There is recent results published regarding the internal brace, morbidity ie pain etc from the procedure is less than an ACL recon and patients do recover faster. The most recent results published show that the return to sport and re-rupture rates are in line with an ACL reconstruction, but without the need to take your hamstrings. It is more common in the paediatric population and there the internal brace is removed at 6 months as it crosses the growing bones and re-arthroscopy has shown healed and tensioned native ACLs.

It is a new way of thinking and will take time for the evidence to build. It is not for everyone and needs to be done early and in those who have the potential to heal (younger). But certainly a good option for those who fit in to that category. The gold standard is still an ACL reconstruction and that can still happen if the repair fails.


Last edited by Ski the Net with snowHeads on Sat 25-11-17 20:40; edited 1 time in total
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@b4d4bing, certainly sounds interesting. Is this procedure being commonly used by professional athletes? You would think they would have the biggest benefit from an improved recovery time. I would imagine football clubs would jump on any procedure that could get their players back a few weeds earlier given what they pay them and the stories one reads about them being rushed back from injury.
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https://www.researchgate.net/publication/309039325_Anterior_Cruciate_Ligament_Repair_with_Internal_Brace_Ligament_Augmentation

https://www.mackayclinic.co.uk/internal-brace-helps-jai-quitongo-return-to-score-wonder-goal/

https://www.mackayclinic.co.uk/internal-brace-surgery-helps-decathlete-return-to-sport/

https://www.mackayclinic.co.uk/cole-back-on-court-thanks-to-internal-brace-surgery/


Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Sat 25-11-17 20:41; edited 1 time in total
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So Zlatan used this technique?
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Update on my sons recovery for anyone interested. Recap. Injury 24th Dec last year, surgery 21st Feb. ACL & ALL repaired using internal brace technique.

Since then physio has been good and continues. He runs, squats, does various jumps and so on. Gets occasional aches but nothing excessive. First trip in two weeks. He is going to travel with us but hasn't decided whether or not to ski yet. It's possibly a little early. He may try boarding instead.
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sounds like he's doing well.


Last edited by Otherwise you'll just go on seeing the one name: on Sat 25-11-17 20:41; edited 1 time in total
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@b4d4bing, a quick google suggests Zlatan was treated by a Dr Freddie Fu in Pittsburgh who specialises in a procedure called the « ACL Double Bundle reconstruction ». This doesn’t sound like the internal brace procedure? In which case the 4-4-2 article on your website is somewhat misleading no?
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
I didn’t write the article. It also doesn’t claim to state that he had an ACL repair. It highlighted the speed of his return to football and that that is unusual for a standard ACL reconstruction. It was also to highlight the new techniques available that could speed up return to sport such as the ACL repair. Ultimately we have no way of knowing what procedure was done unless he tells everyone.

If no one looks and study’s new ways of doing things then we can never move on. ACL repair is new and needs to be done as part of a study and with good follow up and recording of results to make sure we are doing the best for patients and advancing orthopaedics at the same time. So far the results look very encouraging indeed.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@b4d4bing,

You might not have written in but you posted it on your website and it implies that Zlatan recovered in 7 months rather than 9 because he had this procedure. I’m sure you are fully aware that given the surgeon he saw there is no chance he had that procedure.

Absolutely agree with your second paragraph.

Can you name these premier league footballers you refer to? Didn’t recognize any in the links you posted above?

If premier league footballers are starting to use this procedure it would suggest you are probably right. If they aren’t it begs the question of why not?

This is what it says on your website:

“When Zlatan Ibrahimovic made his return from an ACL injury last weekend, he declared that ‘lions don’t recover like humans’. But a new surgical technique could be behind the striker’s miraculous seven-month recovery and is set to accelerate the rehabilitation of a host of other Premier League stars.

An ACL injury typically sidelines a player for nine months – but can take even longer depending on the severity of the injury. “The traditional way to repair the damaged knee involves removing part of a player’s hamstring and using that to create a new ACL,” says consultant orthopedic surgeon, Mark Frame. “It takes a long time for it to fuse to the bone and to restore strength in the hamstrings and quadriceps, because they’re inactive for so long during this process.”

However, knee surgeons are now able to use a different type of operation, which could get players back on the pitch faster. “Advances in keyhole surgery mean we can repair the existing ACL, using a technique known as an arthrex internal brace repair, rather than taking tissue from the hamstring,” says Frame. “We can also place it back in its original position, which reduces the amount of bone which needs removing and hardware implanting. A number of Premier League players have had this type of surgery and have returned quicker.”
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@BobinCH, I've got a draft contract which could do with a clear eye on it at the moment. Care to help? wink
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
@Hurtle, i wish there was a like button. As per the other thread..i am uncomfortable with this but people can make their own minds up. I hope Jonathan Bell is able to contribute a bit more this season
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You'll need to Register first of course.
@holidayloverxx, I'm with you.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Please don’t get me wrong. Having had an ACL reconstruction 2 years ago I am absolutely supportive of research and new techniques that can improve outcomes. But, the first doctor I saw also proposed a repair, rather than reconstruction of the ACL (albeit without the internal brace proposed above) and pushed me to make a decision quickly. The Swiss surgeon, who eventually did my ACL reconstruction, was scathing about the initial the advice I was given based on the evidence available at the time. While Mark Frame may well be an excellent surgeon the purposely misleading marketing of the Zlatan case on his website would make me personally wary. YMMV
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
@BobinCH, I agree, research and new techniques must be the right way to go..and there will always be differences of opinion. I just think @b4d4bing's, approach here is clumsy and has come from nowhere.

(what does B4d4bing mean?)
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 You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
Here’s an update.
I’ve just been at a meeting where the internal brace, the BEAR and direct repair were presented by the individuals championing the success of their approach.

4 years after promising results to us of the internal brace we were once again “ treated”
to a presentation of anecdote and no results.

Difelice( again associated with Arthrex) did present follow up of a small study of repair. He is suggesting repair for children and teens. His early results were good. He suggest that 20% ( those right at the top close to the femur) of ACL ruptures are suitable.
Anything else is a struggle. He did not advocate the use of the internal brace, which he felt unnecessary.

A very high quality presentation on the BEAR with a very credible scientific approach but results too early to prove its worth. This- I believe will be the one to watch, simply because their science is credible.

So in conclusion

Internal brace: a concept without any credible results but that doesn’t seem to trouble them as they are selling it anyway.

Direct repair: some early good results in a small study. But identifying that only 20% are suitable. No need in these for internal brace

BEAR: when results published, we will have good science to know if results are worth taking note of.

I will in future suggest considering direct repair for children/ teens if the tear is very proximal. However, I will be saying the results are from a small study and that a bigger study with longer follow up may not end up supporting repair. I don’t think that we can be any more certain than that.

Jonathan Bell
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 Ski the Net with snowHeads
Ski the Net with snowHeads
Just a quick bump to give a bit more exposure to the feedback above...

@Jonathan Bell, thanks for the update, that's interesting and a little disappointing feedback. As a possible future ACL patient, I so want a repair process to work! It just seems so much more preferable to try to keep a person's original anatomy rather than reconstructing it.

I posted some time ago about how I really wanted to try PRP and/or stem cell treatment for my troublesome knee. Your comment at the time was along the lines of, "Jury's out on PRP - not enough evidence yet" which was fair enough. I'm happy to say now that I have had considerable success with PRP but the Consultant who treated me stressed that PRP is not a physical repair, it's more of a chemical reaction giving long-lasting natural pain relief.

I read this article on BEAR repair https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120682/ which seems very positive. If I've understood correctly, the BEAR approach is effectively an augmented repair with PRP to stimulate cell growth and some other sites discussing PRP suggest that it does help to repair ligaments (but not articular cartilage). I'll try to write a separate post on my experience with PRP so as not to derail this one but from a patient perspective, the BEAR does looks promising.
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