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ACL *repair* experiences ("internal brace")

 Poster: A snowHead
Poster: A snowHead
I agree with @Raceplate: on a brief read of the posted link, the BEAR does look promising, at least in theory, and seems to offer a much less traumatic approach (at least to other tendons) to ACL damage/loss utilising a natural healing process (so I am reading it). I believe that the ACL does have the ability to regrow/heal/reattach, as the MCL can, but normally doesn't becasue it's flapping around in a load of blood or fluid (???) inside the injured knee - hence the scaffold giving it something to cling onto whilst healing.
(Oddly, the exact visualisation which I used - though knowing nothing of this procedure or idea - when desperately trying to encourage my very-recently-ruptured ACLs to grab hold of their frayed ends and regrow/attach themselves. Heck, might even have worked... wink Need a hope and pray emoticon here. )
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@Raceplate,
Itís very frustrating that there are no published results for some of these techniques. Lack of fundings for research is often the block but had a tiny bit of the marketing budget been allocated we would have them.
A cynic might suggest that the lack of results means they are being buried.

The BEAR found whole blood better than PRP in a study they did. They wet the sponge with it.

The PRP/ arthritis literature is showing a bit more promise and I have used it in a small number of arthritic knees with, so far, good outcomes.
Iím watching the mesenchymal stem cell literature very carefully as there is a bit more promise there aswell. Itís a very hot, very hyped topic but we may be seeing some progress. A review paper is out this month which is making me look at whatís available.

The PRP and MSC injections are, as you say, aimed at modifying the response
to the arthritis rather than curing it. That is fine as some manage to live with a worn knee for decades if it doesnít hurt.

Jonathan Bell
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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?
Reading this with interest.
Im now in the torn acl club too, after 35 years of mountaineering and no injuries, the odds have caught up with me, amd In a similar mental position visavis what to do amd who to believe.

Left leg
Ruptured quadriceps muscle, tendon is fine.
compresion fracture postero lateral capsule attachment at the tibia
horizontal oblique tear of lateral miniscus from the anterior horn to the rior articular surface, the rest of it is intact and normal
medial menisucs isn intact and normal
pcl normal
focal acute full thickness tear to acl at its proximal end
full thickness tear to proximal medial ligament with the deep menisco femoral component

consultant is focusing on healing the medial ligament and not to rush in to reconstruction of acl at the moment, but that if i develope subjective instability after full rehab of me knee then it may be necessary further down the line.

part of me wishes that I can recover from this quickly by having the internal brace operation, but then my consultant, who is a knee specialist, want me to heal medial as priority and see him again in one month.

like all things of a specialsed nature, there is a minefield of information to wade through.

If i worked in a sedentary job and only had weekends and annual leave to enjoy hobbies etc then my mindset may be different, But I work full time in the mountains, climbing, hiking, skiing, plus a whole heap of outdoor Ed stuff, So itís my job that is at stake, and hearing a consultant tell me I might not even need an ACL was not what I expected.
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 You need to Login to know who's really who.
You need to Login to know who's really who.
@Markhandford,

The combination of a MCL and ACL is a relatively rare combination. However, sadly, i see it fairly frequently in skiers.

I have treated these non operatively, but rarely, as they do not in my experience do not very often end up with a satisfactory outcome. Even those that "feel "ok at a few months tend to stretch out.

To give you some background. It may be surprising that advice on these matters isn't black and white. This is because the "trend" on how best to treat tends to swing a little from one extreme to another. We are, as a community of knee specialists, in a phase where the pendulum has swung a little away from surgical reconstruction back towards less invasive treatments. It's probably worth saying that we have come from a phase where knee surgeons were offering surgery to virtually everyone. We then get a few studies/scientific papers that question whether too many patients were being offered surgery ( they almost certainly were). Part of this has been a re-interest in using bits of polyester (was a disaster last time round and proven to be this time round). The other is a resurrection of repair - i can assure you the concept of internal brace is not new. It looks like a small number may benefit from repair. Along the way some of us has always tried to take a sensible route that doesn't apply the "current trend" and we apply an amalgam of what we have learned over time.

I think there are, possibly , some patients who will benefit from repair but it will be the minority and i very much doubt ( and there is no evidence ) that the best candidates will be those with combined injuries to the ACL and MCL. The main protagonist of the internal brace has repeatedly failed to publish his results - not a good sign. He was asked when they would be published four years ago at a meeting i attended and the same in November last year.

It is sensible, IMO, to treat the MCL non operatively in the early stages but it needs assessing at about 6 weeks to test if there is any residual laxity - there almost always is if it was a grade 3. Some surgeons, i believe, over treat the MCL so i wouldn't be over concerned at an initial non operative treatment of it. At about 6 weeks i would then tend to offer reconstruction of the ACL and, usually , a bit of work on the MCL. However each case must be taken on its merits. That is to say we need to take into account what you want to do ( alot in your case) , the laxity, the other damage to the knee etc.

Get your self to a point where the MCL has healed - are you in a brace? Then see what the advice is, and if uncertain, get a second opinion.



Joanthan Bell
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Thank you for such a straight forward email and your expert opinion.
It follows what my consultant has said, heal the mcl with physio and rest and to gain range of motion.

I donít start physio for a week or 2.

Iím in the nhs Hospital fracture clinic tomorrow.

Iím back to consultant late March.

Iím currently in a hinged brace set at 20 degrees and I can straighten my knee pain free when itís horizontal. But canít do this when Iím standing, too much swelling in my knee, it hasnít gone down much.

I need to be able to hike, in summer,
Kick steps in hard snow and Ski mountaineer in winter, plus swim in the sea and scramble up and down mountains - am I asking too much Smile
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 You'll need to Register first of course.
You'll need to Register first of course.
@Markhandford, so sorry to read of your plight. Hope you have a full and swift recovery.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
Many thanks for the thanks @Hurtle Smile
Im looking forward to getting fixed hahaha
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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!
Markhandford wrote:


I need to be able to hike, in summer,
Kick steps in hard snow and Ski mountaineer in winter, plus swim in the sea and scramble up and down mountains - am I asking too much Smile


It depends which summer! 2019 yes with limitations, 2020 at full strength. Goals are vital. Men's downhill has just been won in Korea by a guy 2 years post ACL reconstruction and 1 year dislocated meniscus. Next to him our demands are modest!
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