Who Will Respond to an ACL Stem Cell Procedure?

by Chris Centeno, MD /

ACL stem cell procedure

This weekend, I’ve spent hours and hours poring over more than 50 before and after MRIs from patients who have received the ACL stem cell procedure we invented. This is the world’s largest collection of data to date on what happens when stem cells are precisely injected into ACL tears. I took a few of those images and crafted the collage you see above out of some of the before shots where patients got complete healing of their torn ACL. Why review all of these images? To find out who might fail this procedure and why.

Healing ACL Tears with Precise Stem Cell Injections

First, ACL surgery is invasive and doesn’t result in anything like the original equipment being replaced. While most patients believe that getting their ACL surgery means a new knee with a new ACL where the old one used to be, what they really get is a bunch of holes drilled in the bone and a tendon put in at the wrong angle to replace the torn ligament. This results in everything from high retear rates to poor position sense in the knee to an earlier onset of arthritis.

Way back in 2011, I thought about whether it would be possible to use imaging to precisely inject the patient’s stem cells into a partial ACL tear. After all, this could save the original ACL. After trying various methods, it turned out to be surprisingly difficult to accurately perform this injection. However, by 2012 we had begun to get it dialed in, and by 2015 we had it, for the most part, perfected. We published a small pilot study on ACL stem cell injections a few years back and have now submitted a bigger study for publication. We also continue to recruit for a randomized controlled trial.

One of the more amazing things is that despite the evolution of this ACL stem cell procedure, the retear and failure rates have been surprisingly small, much less than 10%. Initially, that was because we only tackled easily treated tears (partial ones), but as time wore on, we began treating bigger and bigger tears. However, when the novelty of seeing these tears heal on MRI wears off, it’s time to buckle down to let the data tell us who is and who isn’t a candidate for our ACL stem cell procedure. Hence, this weekend’s MRI fest.

Offset and Other Measurements

About two years ago on Linkedin, a smart radiologist mentioned that we might want to start measuring the offset of the femur relative to the tibia and that this could be helpful in looking at candidates for our procedure. The idea was that since the ACL prevented the tibia from moving forward on the femur, the more trashed ligaments, despite what they looked like on MRI, would allow more movement. This measurement would, therefore, help to quantify more damaged ligaments that might not respond. In general, these measurements seemed to work well, but confirmation bias is an interesting research gremlin. Meaning that thinking you know what’s happening without looking at the objective data can get you in trouble.

This weekend, while measuring each and every one of these MRIs, I noted that some of our successes had awfully big offset measurements, kind of putting a hole in my theory that these measurements were the sole key to defining candidates. While I was able to use some ratios that compensated for the fact that 7 mm of offset in a small woman’s knee was different from the same offset in a large man’s knee, there needed to be another parameter to create a model that could accurately predict patients who were highly likely to fail the therapy.

Morphology or How the ACL Looks

One of the things that became clear from my ACL MRI review was that how the ACL looks may be just as important for predicting who will respond to an ACL stem cell treatment as the offset. Thankfully, I was able to identify some configurations of the ACL that just aren’t compatible with a ligament that will heal.

Creating a Decision Matrix for Our Regenexx Providers

This next month, we’ll begin introducing our providers to a new decision tool that will help them predict if a patient is a good candidate for an ACL stem cell procedure. That tool will also be collecting data to grow smarter as the years progress. The goal is to continue to collect data so that after thousands of ACLs have been treated, Regenexx providers can predict with the highest accuracy possible who will respond and who should be told to skip the procedure.

The upshot? While experienced stem cell providers may have treated a handful of ACL tears with stem cells and consider everyone a candidate for this new procedure we pioneered, at Regenexx we’re moving beyond that into the next phase in any treatment—candidacy. Our new ACL stem cell procedure decision tool will be based on the world’s largest data set of successful and not-so-successful ACL procedures. It will grow smarter and smarter, allowing Regenexx providers to be the only group worldwide with an accurate crystal ball that knows whether you’re a candidate to skip invasive ACL surgery or not.

Leave a Reply

Your email address will not be published. Required fields are marked *

14 thoughts on “Who Will Respond to an ACL Stem Cell Procedure?

  1. Joe Hastings

    Thanks for the great work and continued progress!

    I imagine a lot of candidates will be considering pros/cons of this procedure compared to reconstruction surgery. Do you have statistics on the (“<10%") failure cases such as the length of time to failure and whether or not the candidate then had reconstruction surgery?

    In particular I imagine a lot of people will try this procedure with the plan that if it failed they would then have reconstruction surgery. If they made that decision in say 3-6 mos they honestly wouldn't be that far behind the conventional route (ignoring the flaws of reconstruction and assuming a typical surgical result) but if this took more like 12-18mos it'd be a different experience with potentially a loss of 1-2 years of athletics (again assuming a typical surgical result and ignoring all the complications and negatives of reconstruction). Your "<10%" failure rate is amazing and I don't mean to focus on the negatives but I am curious if you could say anything about the breakdown of those poor outcomes?

    1. Regenexx Team Post author

      Joe,
      Objectively, ten percent failure rate is amazing when compared to surgery, and to the issues that result from ACL surgery, like high re-tear rates, poor position sense in the knee and an earlier onset of arthritis. For an athlete given the success rate and drastically shortened return to play, these procedures can be career savers. Please see: https://regenexx.com/blog/acl-surgery-return-to-play/ and https://regenexx.com/blog/acl-surgery-return-to-sports/ https://regenexx.com/blog/long-term-effects-of-acl-reconstruction-surgery/ and https://regenexx.com/blog/another-perc-aclr-procedure-sucesss-acl-tears-stem-cells/ and https://regenexx.com/blog/acl-tear-surgery-or-not/ and https://regenexx.com/blog/nfl-acl-surgery-2/ Lots more in the blog section….

  2. Nancy Thorne

    Dr. Centeno.
    Dr Handelman fixed both my meniscus and ACL tears 15 months ago. I am now about 80% back to “normal”…..but at 65 years old this new normal is fine.
    Thank you, Nancy Thorne

    1. Regenexx Team Post author

      Nancy,
      Great news! We’ll share with Dr. Handleman.

    2. Marsha

      Hi, Nancy. Can you tell me, was this done in the U.S., or in the Cayman’s? That may make a difference in success, and I’m in the process of deciding whether to have my meniscus tears done in Arizona, or just abandon the possibility, since I know I can’t afford the Cayman Islands procedure. I’m 65 also. Any suggestions you can give me? I’m really tired of walking around with this crutch 🙂
      Thanks, Marsha

      1. Regenexx Team Post author

        Marsha,
        Dr. Handleman was not performing procedures in Grand Cayman 15 months ago, so it would have been in California.

  3. Marsha

    Dear Dr. Centeno and Regenexx,
    I cannot thank you enough for your diligence in pursuing treatment for these critical issues. It makes such a difference in a person’s quality of life, and until I tore my meniscus, I had no idea, and took my health and mobility so much for granted. The work you do is so important.
    Thanks, Marsha

    1. Regenexx Team Post author

      Thanks Marsha!

  4. Tricia Michel

    Dear Dr Centerno,

    Will receiving a stem cell treatment during ACL surgery speed my recovery time? I was not a candidate for Stem Cell alone as my ACL is completely torn.

    1. Regenexx Team Post author

      Tricia,
      It may help the graft adhere to the bone tunnels. Have you been evaluated for a Regenexx ACL procedure?

  5. Peter Hunt

    Which type of MRI image do you need, DICOM or just JPEG?

    1. Regenexx Team Post author

      Peter,
      Once you submit the Candidate form, you’ll receive an invite and instructions on how to share your MRI images.The Doctor will need the entire series.

  6. Foram

    I have meniscus tear in knee, plz guide which treatment gives better n faster result : surgery or stem cells or surgery+stem cells? what are the side effects and success rate? By proffesion I am a dancer and so I want to know whether i can get back to my profession or not?

    1. Regenexx Team Post author

      Foram,
      Meniscus surgery is a net negative for everyone, but even more for someone who puts the type of demands a dancer puts on knees. Meniscus surgery does not repair the Meniscus, it removes sections of it, leaving the knee cartilage exposed to unnecessary wear and tear, and leaving the knee unstable. Whereas as using your own stem cells actually repairs the tear, keeping the biomechanics of the knee healthy. Please see: https://regenexx.com/blog/should-i-get-meniscus-surgery/ and https://regenexx.com/meniscus-tears/ and https://regenexx.com/blog/does-meniscus-repair-work/ To see if you’d be a candidate, please submit the Candidate form.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.