Cruciate Ligaments

Doctors Experiment With New Way of Fixing the ACL

Preliminary results suggest that healing an original A.C.L. without the usual grafts may be a viable option in the future.

mobile.nytimes.com|By Catherine Saint Louis


Knee. 2014 Mar;21(2):462-70. doi: 10.1016/j.knee.2013.10.009. Epub 2013 Oct 23.…
www.ncbi.nlm.nih.gov|By Smith TO , et al.

Not all ACL tears require surgical repair. Much depends on the demand the patient places on the affected knee. Conservative treatment may be adequate for the elderly and more sedentary. This literature review suggests that functional and pain outcomes are similar, with surgical repair favouring less progression to secondary Osteoarthritis.


Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients…
www.ncbi.nlm.nih.gov

I could only find 1 case report of a "successful" treatment of a complete ACL tear with prolotherapy using mainly 50% dextrose as sclerosant.
7 fortnightly injections into the purported ACL site without sonographic guidance. Some sessions included tender points injections, and one was intra-articular. Bizarre. But it apparently worked: the ACL was reconstituted albeit by scar tissue, function was satisfactorily restored without sensation of instability.
One wonders if, in such a young person, similar healing would not have happened anyway in 15 weeks without intervention.


 
www.sciencedirect.com

Jay Smith's cadaveric proof-of-concept that it is possible to inject the ACL accurately under sonographic guidance.

 
www.sciencedirect.com

And here's Jay Smith injected the PCL of a cadaveric specimen, under sonographic guidance.


Patient with partial tear of the Anterior Cruciate Ligament (ACL), Musculoskeletal ultrasound Guided Platelet Rich Plasma Injection to the ACL insertion…
youtube.com

Stanley Lam injecting PRP into a real patient with partial ACL tear on ultrasound (complete tear reported on MRI).
This demonstrates that it's possible to access almost the entire length of the ACL sonographically, but I am not aware of the medium to long term outcome of such non-surgical procedures, especially when compared to surgical repair. A head-to-head study would be greatly informative (unblinded though).
But first, a single-blinded study comparing PRP, prolotherapy and placebo (no injectate into, or fenestration of ACL after needle past skin) should be done to compare intervention vs conservative treatment on pain and functional outcomes.

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