The single biggest MRI result that we see day in and day out that never ceases to amaze me is a postinjection image after stem cells have been injected into a trashed ACL. While the images look fantastic, usually showing ACLs that have transformed themselves from tattered messes into something resembling a normal ligament, many surgeons who perform ACL-reconstruction surgeries for a living have questioned whether these stem-cell-injected ACLs could ever hold up during sports. So this morning I’ll share an image plus the report of a competitive beach-volleyball player and avid Telemark skier who received an ACL stem cell shot in the knee.
ACL Surgery Has Its Problems
ACL surgery does have its problems, but before we look at these, let’s review the ACL. The anterior cruciate ligament (ACL) is a main ligament of the knee. It allows for precise movement and provides stability in the knee. The ligament attaches at the bottom of the femur bone (the long upper-leg bone), stretches through the middle of the knee, and connects to the top of the tibia bone (the larger lower-leg bone). The rotation and the front-back motion of the knee are controlled by the ACL, and this control is what gives the knee its stability. If the ACL becomes injured or torn, common in athletes and people involved in activities that put a lot of pressure on the knees, the knee can become unstable.
Orthopedic surgeons will usually recommend an invasive surgery called ACL reconstruction in which the old ligament is removed and a graft is inserted in its place. However, a knee with a reconstructed ACL will never function like it did prior to your injury. Why? Some of the ACL surgery problems I’ve shared here over the years follow:
- ACL surgery permanently alters the mechanics of the knee.
- During ACL surgery, the graft, the new ACL, is attached at a steeper angle, causing rotational instability of the knee and disrupting the normal position sense following surgery.
- ACL surgery destroys the wiring and circuitry in the knee as there is no way to connect the knee’s microscopic position sensors (of which there are thousands) to the graft. Destroyed wiring means there is no way for the graft to communicate and coordinate with the muscles.
- After ACL surgery, active patients are six times more likely to tear the ACL in the other leg or retear the one in the same leg.
Many people also believe ACL reconstruction will minimize the risk of arthritis, but this is not true. Not only does ACL surgery not prevent or minimize the risk of knee arthritis, but it may even accelerate the onset.
Now, let’s look at David’s experience following his ACL stem cell shot and his before and after images above.
David’s ACL Stem Cell Shot Story
David first saw us just three weeks before he was scheduled for an ACL reconstruction (ACLR). He told Dr. Markle that two weeks prior to that visit he had heard an audible pop in his knee while Telemark skiing. He had already been evaluated by two orthopedic surgeons, with MRIs showing an ACL tear. They both wanted to operate, so he had the surgery scheduled, but then he heard about Regenexx and wanted to see if he was a candidate for our novel Perc-ACLR procedure (percutaneous ACL repair).
In January of 2016, David received a precise injection of HD-BMC (high-dose bone marrow concentrate) into both bundles of his ACL. By three months the knee was feeling more stable without pain and he was using an ACL brace to protect the area. By nine months out, Dr. Markle decided to provide a HD-PRP (high-dose platelet rich plasma) booster shot into the ligament due to some mild residual laxity noted on exam.
The above images are before the injury and six months after the injection. Note that the ACL on the left is bright and barely seen, outside of some stringy fibers moving in the general direction of where the ACL should be. Now note the six-months-postinjection image to the right. The ACL fibers appear more normal in appearance. However, the big question is, how did this knee hold up in sports? Dr. Markle received this from David:
“Hi Dr. Markle,
The upshot? I love seeing these postinjection MRIs of knees that have been treated with our Perc-ACLR procedure (an ACL stem cell shot). Even more, I love seeing how people are using their knees in high-level sports and chuckling that some surgeon told them that their ACL needed to be yanked out and replaced with a poor tendon substitute!