 Poster: A snowHead
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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...  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
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@Raceplate,
It’s 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.
I’m watching the mesenchymal stem cell literature very carefully as there is a bit more promise there aswell. It’s 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 what’s 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 doesn’t 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?
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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 it’s 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.
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@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.
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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 don’t start physio for a week or 2.
I’m in the nhs Hospital fracture clinic tomorrow.
I’m back to consultant late March.
I’m currently in a hinged brace set at 20 degrees and I can straighten my knee pain free when it’s horizontal. But can’t do this when I’m standing, too much swelling in my knee, it hasn’t 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 
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You'll need to Register first of course.
You'll need to Register first of course.
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@Markhandford, so sorry to read of your plight. Hope you have a full and swift recovery.
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Many thanks for the thanks @Hurtle
Im looking forward to getting fixed hahaha
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| 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 |
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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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.
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@Markhanford, 'A Bay' Colorado took my ACL and had a good go at my MCL on Dec 30th. I'm not in your league, either on the injury or activity front, but as a fairly active half centurian, was looking forward to the top of Cotopaxi in July this year. As with many on this site I read all I could, struggled to digest the information, struggled to find much on those who 'cope' without an ACL - skidivas is good for this, questioned the mind vs physiology, thought about the costs, both financially and on getting on with life, and ultimately did what was right for me - it will be different for everyone. 5 weeks ago Prof Wilson stitched my ACL back together and threaded the 'internal brace' through it, using tape that has been used for a good 10 years plus in other orthopaedic procedures. I'm not back running yet - hope to next month, but I can walk in the country (rough ground) for an hour or so, or do a session of cardio and resistance for an hour, the ROM on my repaired knee is within about 15% of my good leg, it's been hard work but I can hyperextend my leg, my KOOS score is at over 80%, and I feel positive - I haven't always over the last couple of months. if you are thinking of repair, don't leave it too long, as there's an optimum time post injury for the surgery. Good luck with whatever you decide
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@ACLess, Thanks for your post, glad you are on the road to recovery
So it’s now 7 weeks post accident.
I have 90 degrees flexion and swelling has gone down considerably.
Consultant was very happy with progress so far and was surprised that my mcl has healed so well and now have no pain on it, not so medial condyle which gives 8/10 pain when poked with finger pressure., not sure what that is all about, and no feedback on what it could be.
Still a definite no to surgery from the consultant, he has told me no need for the hinged brace anymore and to continue and perhaps increase physio, with the objective of as much ROM over the next 6 weeks, aiming for same ROM as good leg. And to be more weight bearing and less reliant on crutches at the end of the 6 weeks.
And as summer approaches to get out hiking and see how things progress.
If there is instability present that he will review.
I have tried and tried to increase my knee bend, but it comes to a solid stop, with feeling of explosive pressure inside my knee that wants to burst out the medial side of my knee cap,
Also the pain 10/10 is not in the same place inside my knee all the time.
So mentally I’m all set for upping the rehab and to give it 100% for the next phase- ruptured quadriceps muscle is starting to get better and not so flabby.
I don’t know what my laxity score was, but he was really happy with my progress.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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@Markhandford, Good to hear you are on the mend. On the the surgeon is saying no to the ACL reconstruction, is that because more rehab is required or just because he thinks you can do without ?
IIRC I wasn't using crutches when I went in for mine.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| AndAnotherThing.. wrote: |
@Markhandford, Good to hear you are on the mend. On the the surgeon is saying no to the ACL reconstruction, is that because more rehab is required or just because he thinks you can do without ?
IIRC I wasn't using crutches when I went in for mine. |
By the time I had my ACL recon my knee felt almost normal and I had full range of movement back, something which the consultant insists on before doing the recon.
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Thought I’d update the forum a year later...
I bust ACL and tore medial skiing in March 2017 and reported on this a year ago. Prof McKay was very nice on phone but booked me in to have op without seeing me provisionally which kind of alarmed me, as did the fact he declares a commercial interest in the product he is using. Neither should put anyone off as he may be genuinely brilliant and kind but it just put me off a bit. Went to see Sam church in fortius in London. He refused to operate for first 16 weeks to heal medial and then refused again as doing pretty well on rehab. Had two awesome physios, one a technician who is an ex international water skier and the other more sporty.
First time I got on bike I could not even do one turn; I cried! Within a week though through gritted teeth managed to go round, it’s helpful to get on a rowing machine in my view as you can control how much you bend and slide into it...I used to mark it and each day try to do one mm more ... slow progress... but within 3 months into squats... and I mean into them : did 10,000 one legged jobs, then onto trampoline doing another 5000... loads of one legged leg presses and all bespoke stuff for each of the quad muscles... anywAy one year later back on the slopes with a one to one instructor and an issue brace. On GREENS for a day, blues for two days as instructor would not let me do anything else but back on the off piste blacks by end of week, confidence fully restored having a total ball at least on skis. So pleased that I feel I got the right advice from Sam church and did physio as opposed to the op two other surgeons inc prof McKay suggested I have. I never think about the knee now at all. I actually splurged our the fish and have 2 braces an ultra light one for ocean surfing and hiking and a light one for skiing which is a bit stronger in case I hit a rock!
To be honest after 15000 squats my knee feels as if it’s in the best shape it’s been for years.
Moral of tale: everyone is different, my ACL was torn in the middle and I didn’t have a positive pivot. In 40% of these cases the frayed edges of the ACL can attach itself to the PCL and stabilise; also seem to have been lucky with the medial teAr as it seems to be stronger having healed than it was before, must have been all those one legged squats and leg presses.
I gather from fortius that the knee takes 18months to repair... it continues to repair for a long time even if you think you are ok. The footballers who go back after 9 months etc etc are taking a risk... the club wants them back, they need the contract financially, life is about risk and they take that risk. I think what I learned was don’t take undue risks without a custom brace in the first 18months unless someone is paying you shedloads. The guy I saw - Sam church - had ruptured his, played rugby without one for some years, then had a replacement and has I think also had a revision so knew what they all felt like.
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You know it makes sense.
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Sorry for the typo! I have two OSSUR CTI customers made braces. Awesome.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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I had internal brace & ALL done 5 weeks ago after extensively researching medical journal articles on BEAR (entering trial 3), IBLA and then internal brace, all showed better stats than reconstruction in studies comparing them months later, at 1 year check points, and 2 years later.
The first internal brace was done in 2011 (7 years now) and first BEAR in 2015 (I've contacted the recipient) - the ACL regrows after these procedures.
Among many athletes receiving internal brace, British skier Jai Geyer has received 2.
posting details on facebook & instagram @ryancartiers if you are interested in following the progress.
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Poster: A snowHead
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@@ryancartiers, when are you planning on returning to skiing?
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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I want to give it 6-9 months; if I was only regrowing the ACL I might target November, however there was more extensive damage so I'm being cautious and thinking February. All dependent on actual progress.
My goal is to let everything heal & achieve best possible outcome to provide another example how this works, to support patients in receiving the option not to remove organs unnecessarily & strip good tissue from hamstrings or elsewhere to reconstruct them - when this is an option for their injury of course.
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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?
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@@ryancartiers, How is your recovery going then?
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You need to Login to know who's really who.
You need to Login to know who's really who.
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@Sweetpea, how's it going for you, too? Have you posted in the no ACL thread (all these attached and unattached and reattached ACLs, getting me terribly befuddled  )
I'd agree with the 18 month bit; at least 18 months and keep on going.
There is a possibility that my ACLs also reattached to the PCLs or something else within the knee, though no-one knows or has checked. Like yours they also apparently tore fully in their middles. I don't know how vulnerable they then are to de-attaching again, or how much stability they offer if they have indeed reattached to a nearby helpful 'friend', nor what restrictions or other issues this could throw up as regards the knee and related bits of leg: there's very little published or studied on this aspect as far as I can see.
My NHS consultant was very strongly against using braces, secondary injury transfer etc. I've done OK ish so far without them, but am still wondering about getting some on a preventative basis (mortgaging an organ might be required to purchase, though).
Oh, and I initially also enquired of Dr McKay and got an impression that it was easy to book in to have the op quickly and recently after injury, but that there wasn't a huge amount of consultation, advice, discussion or selection for suitability first, so I also felt uneasy about proceeding. Maybe that's just the way phone enquiries are handled, but there was no impression that any advice would be offered to assist a decision as to whether it was the right way forward - not, at least, without paying your money first. By which time my physio was already making reassuring conservative management options.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| Sweetpea wrote: |
| Find a guy who doesn't 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 |
I fully agree with this. It took a lot of searching on my end to find it.
regarding re-attaching to other ligaments, I have not seen this in my research nor has anyone I've spoke with or any of the surgeons brought it up as a risk - however I haven't searched it either, so do your research*
I did a quick search and there's stats on this
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You'll need to Register first of course.
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| Markhandford wrote: |
| @@ryancartiers, How is your recovery going then? |
still making progress, icing as I type this after massage, she said patella is still loosening (it is compressed still). Hit 125 degrees and have started using BOSU ball Monday.
Here's the 1st article I found was how a 12 year old boy suffered a complete traumatic rupture of his #ACL, which intrinsically healed.
You can find the article
“Intrinsic #Healing of the Anterior Cruciate Ligament in an Adolescent”
in
The American Journal of Orthopedics, August 2015
https://www.amjorthopedics.com/article/intrinsic-healing-anterior-cruciate-ligament-adolescent
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| @ryancartiers wrote: |
| Sweetpea wrote: |
| Find a guy who doesn't 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 |
I fully agree with this. It took a lot of searching on my end to find it.
regarding re-attaching to other ligaments, I have not seen this in my research nor has anyone I've spoke with or any of the surgeons brought it up as a risk - however I haven't searched it either, so do your research*
I did a quick search and there's stats on this |
Good surgical results are all about consistency. Most operations go smoothly but a proportion throw a curve ball.Surgeons who are perceived as technically good can deliver a good outcome consistently even in the technically challenging cases.
You do see surgeons who over complicate even seemingly straight forwards operations and end up doing something different every time. That does not deliver consistency. They are always using a bit of new kit or a new technique for the first time.
Some surgeons will just do the same technique for every ACL reconstruction on the basis that they feel, for the numbers they do or the years they have been a surgeon, it will be a technique that they can be consistent with. So there are good reasons that a surgeon may say " in my hands this is the technique that I can do best"
It is this fact that has partly driven some to super specialise. There are very few pure knee surgeons but they should be familiar with different techniques- and more important be able to deliver consistency with them. There is therefore a balance.
There is always an important discussion about whether any surgery should take place .If my patient and I have decided that surgery is required I offer a hamstring reconstruction 80% of the time. Results in a straight forwards situation deliver consistency. I may vary from that if the MCL is lax, the patient is hyper mobile, had significant hamstring injuries or if the patient specifically requests an alternative. My goto then will be a patella tendon. I'm equally happy with both . Quad tendon is being revisited but I'm yet to see any published advantages. Allograft ( donated tissue) has no place in a first time reconstruction other than in very unusual situations.
Repair. Still a very frustrating lack of published literature. I see a lot of children ( over 10's usually) from the large number of skiing families whose children race. Repair isn't really that new but died out due to poor results. There is a small literature that suggests that a specific pattern of ACL tear can do well with repair. Children have very high rerupture rates for reconstruction and on that basis I've been offering repair to the children if the pattern of tear is very proximal.
I do discuss repair with adults but always have to say that there are few published results.
I hope helps guide the sort of conversation you should have with your surgeon.
Jonathan Bell
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@Jonathan Bell, interesting to hear. A friend of mine was very strongly advising me to try the internal brace procedure when I had my injury. He was a fellow hamstring graft ACLer who found rehab though and stopped doing his physio pretty early on. To say he wasn’t very active even pre injury is a huge understatement so I think he didn’t know what had hit him with rehab. His line was that I might as well try and shorten the recovery, which is so miserable, and if the brace doesn’t work for me I’m no worse off, I can have the standard reconstruction. I didn’t know much of what you mention above at that point. But what decided me against it was that two surgeries rather than one if it doesn’t work isn’t “no worse off” in my book. Two sets of messing with the knee, inflammation, muscle shut-down and atrophy, possible scar tissue-it didn’t sound like a no risk option at all. I decided I’d rather take the better known longer recovery of the autograft reconstruction, in the fervent hope that I’ll only have to do it once. I went for hamstring autograft. Even though it turns out my hamstrings aren’t great (I mean even pre-graft) and I have a bit of structural genu valgum which has meant a slower recovery, I still think that was the right choice for me. A personal choice of course, I know others will disagree.
Last edited by After all it is free  on Sun 23-09-18 19:00; edited 1 time in total
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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.
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Oh, and quickly, as I don’t want to derail the thread away from the repair discussion - the first surgeon and the first physio I saw both tried to talk me into allograft, also in the name of a quicker recovery for a 36 year old like me. Again, the higher failure rates I read about made me think I’d rather do this just once (fingers crossed), even if it takes longer. So I went with a different surgeon - and physio.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| Jonathan Bell wrote: |
Some surgeons will just do the same technique for every ACL reconstruction on the basis that they feel, for the numbers they do or the years they have been a surgeon, it will be a technique that they can be consistent with. So there are good reasons that a surgeon may say " in my hands this is the technique that I can do best"
It is this fact that has partly driven some to super specialise. There are very few pure knee surgeons but they should be familiar with different techniques- and more important be able to deliver consistency with them. There is therefore a balance.
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The surgeons I came across performing internal brace & graft knee surgeries also did ankle & shoulder surgeries - ankle seemed to be perhaps a higher proportion. This is just a small pocket perhaps.
Last edited by snowHeads are a friendly bunch. on Sun 30-09-18 8:37; edited 1 time in total
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| BorntoRun wrote: |
| @Jonathan Bell I might as well try and shorten the recovery, which is so miserable, and if the brace doesn’t work for me I’m no worse off, I can have the standard reconstruction. ... I decided I’d rather take the better known longer recovery of the autograft reconstruction, in the fervent hope that I’ll only have to do it once. I went for hamstring autograft. ... A personal choice of course, I know others will disagree. |
If it's just the ACL functional recovery to jogging down a hall & hopping can be 6 weeks (you can find videos online, another one of the girl who plays soccer was posted a few weeks ago), however every case is different - and there's still healing, ROM & physio for 6 months regardless, and you'll find the consistency that failed repairs in both BEAR & IBLA were due to returning to sport too early, before strength & rehab was complete.
Other damage will draw it out past the 6 month point; in my situation I'm anticipating between 6 - 9 months.
Even if you have a graft issue later, U.Conn. is starting the trials to regrow ACL's from stem cells so expect to have the option to replace your graft with a real ACL at some point in the near future.
I wouldn't heed those who disagree, as you said, it's a personal choice. At least you had the options available to you - no surgeons in Alberta Health Services or from my searches - in the Canada public health service - offer this yet. Hopefully this changes soon or they become easier to find.
Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Sun 30-09-18 8:34; edited 1 time in total
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You know it makes sense.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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@@ryancartiers, the UK National Health Service doesn’t offer internal brace either, and not even allograft for standard first time reconstructions. Too expensive! I was lucky enough to have very good private health insurance through work. What that meant in effect was that I had those choices - even though I went for the standard autograft in the end- plus no waiting time for my chosen surgeon. I could have had the same surgeon on the NHS with a four month waiting list, as it is I had the operation as soon as the knee had settled, 6 weeks post injury, going private. It turns out that was a big big advantage because I also had a meniscus tear that the MRI hadn’t picked up- and the sooner you try to fix those, the higher the success rates. The other huge thing I got with the private insurance was exceptionally good physio - not just more frequent sessions for a longer period, but also a whole other level to what I would have got on the NHS. I’m a big fan of the NHS and I understand that it can’t do everything at its current levels of funding. But I wish we’d all pay a bit more towards it, so that those who aren’t lucky enough to have private insurance don’t pay the price in their long term health...
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@BorntoRun, You were lucky and well-served there. My NHS input, bar a self-organised emergency knee clinic referral (thanks to SHds' timely advice) and the 'luck' of having the MRIs already done in resort courtesy of the insurance company (MPI - and the knee clinic A&E wouldn't have seen me without them), was 2 quick outpatient meetings with a Consultant and that was that. Hopefully I can say that luckily I didn't need more, and hopefully had I needed more I would gave got more. Physio was not offered and not available or accessible at the hospital anyway. I managed the regulation 6 sessions arranged via the GP self refer scheme but that was it and he knew very little about knees or rehab for active people. GP referral earlier this year even less knowledgeable. I did luckily have a knee specialist in a local private clinic and got the insurance to pay for a few sessions, then self funded a few more myself, and will do so again if needed (though finding a specialist up here is not so easy). It is luck of the draw, and geographical location, as to what is on offer or available; that runs to gyms too (never mind their extortionate costs if you actually have one nearby or pass one when commuting).
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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?
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@Grizzler, I’m very aware that I’ve been very lucky with my treatment. That’s partly why I’ve been following my physio’s instructions to the letter, and doing all my exercises religiously. It would be such a wasted opportunity not to!
I’m also very grateful that I had the surgery early enough to try the meniscus repair. I’m aware there are no guarantees it will work, especially as I’m in my mid thirties now. But I’m so glad they were able to give it a go.
I’m in awe of your self-directed recovery. It’s a bummer of an injury in the way it messes with your head, so it takes a whole other level of self motivation and will power to rehab it under your own steam.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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| BorntoRun wrote: |
| @@ryancartiers, the UK National Health Service doesn’t offer internal brace either, and not even allograft for standard first time reconstructions. Too expensive! I was lucky enough to have very good private health insurance through work. \ |
It's really disappointing the NHS doesn't offer internal brace - it costs less to perform for the NHS, and people recover faster - again less medical cost burden for them; they can get back to work faster - better for both patient & 'economic contribution' from the government's point of view.
I think it's only a matter of time before they adopt current practices. It's been around for 7 years - I'm told the medical industry usually waits about 10.
Awesome you have the insurance, it's really worth it in many cases.
I'm still sorting my situation out.
Got new exercises this week, still making steady progress
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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posted these links on my page this week - from PRP (Platelet Rich Plasma) research I did to figure out if it was an option,
concluding it was not going to maintain the clot for healing. (you may find otherwise - they're still learning about it & stem cells)
https://www.rejuvmedical.com/wp-content/uploads/2016/03/B4-PRP-Matrix-Graft-Crane-1-08.pdf.pdf
Here’s the one that indicated to me more than PRP was needed:
Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament?
A Systematic Literature Review.
Carola F. van Eck, MD, PhD, Orr Limpisvasti, MD, Neal S. ElAttrache, MD.
August 7, 2017
An electronic database search was performed to identify 89 papers describing preclinical and clinical studies on the outcome of ACL repair.
“Augmentation with platelet-rich plasma was beneficial only in combination with a structural scaffold.”
http://journals.sagepub.com/doi/abs/10.1177/0363546517717956
“is there an inherent matrix to place the graft in, or will the graft be washed away with motion, synovial fluid, or repeated graft compression or distraction?”
more links on the 3 ACL regrowing options to follow...
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You'll need to Register first of course.
You'll need to Register first of course.
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Thank you all for this thread! This is the most informative discussion about this topic that I can find, and I created an account just to continue the discussion. I do love to ski (and hope to ski once my knee is up to it), though I probably do not qualify as a true snowhead.
I am posting because I had an ACL primary repair with internal bracing 3 months ago. I'm a 30something recreational athlete who tore my ACL playing soccer and did not injure any other structures. I tried rehab at first, but my knee was still noticeably unstable. Surgery was 3 months post-injury, but I had good tissue quality, with the ACL scarring onto the PCL, and a proximal avulsion tear. Post-surgery, my surgeon described the condition of my knee as ideal for repair.
Reading this thread, particularly Jonathan Bell's responses and learning more about the internal brace has caused me some concern. While my injury may be ideally suited for repair, having polyethylene permanently in my knee is pretty scary, given the history of artificial ligaments. The internal brace is not supposed to function as an artificial ACL, but even if my ACL becomes functional again, I am worried about what could happen when the material in the brace wears out. Prior to surgery I did not know much about repairs, except that they were a new approach after previously being abandoned. My surgeon said he would see if things were right for a repair, but he did not try to sell me on the idea, and it seemed likely that I would need a reconstruction.
My surgery was performed by a highly reputable, high-volume surgeon who performs a large number of reconstructions (including on million-dollar professional athletes) using the more conventional approaches at a highly rated large hospital in a major US city. The procedure was covered by my health insurance (which is far from a given in the US). Maybe this is the wrong place to ask, since many posters are not American, but how can such an "experimental" procedure with little long-term evidence be covered by health insurance and used by a reputable doctor as a first-line treatment? In the US, malpractice lawsuits are everywhere, so I am surprised that they would take the risk.
I also want to add that 3 months out I am very happy with the results (though I obviously can't compare them to a reconstruction). My knee feels stable again (I had good ROM and was fully mobile before surgery), my muscle tone is returning, and the swelling is gone. I have full extension and flexion. In PT I have been hopping (including laterally), jogging, and doing wacky exercises that build confidence and balance. I will answer any questions about the process/recovery. Osteoarthritis is likely in all ACL-injured knees, but I would like to move on from this injury and not worry that a piece of plastic is going to disintegrate in my knee someday. I have done a ton of literature review, and a lot of it is comforting, though the lack of long-term findings is a big question mark. People have pointed out that the first of these procedures was done 7 years ago, but I believe it was only done at higher volumes from around 2016. Dr. Bell points out that repairs can be suited for a subset of patients with proximal avulsion tears and good tissue quality, and the literature (and my surgeon  ) also support this idea. Given the frequency of ACL injuries, maintaining the native tissue for the ~20% of cases that this approach is indicated for would be well worth attempting. But what about the internal brace?
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@EastCoastUS, Welcome to Snowheads!
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I do love to ski (and hope to ski once my knee is up to it), though I probably do not qualify as a true snowhead.
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Sounds like you passed the entrance exam right there 
Hope your recovery continues to go well.
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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.
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