Another day, another MRI of a patient whose ACL was destined to be ripped out and replaced, but due to an ultraprecise stem cell injection procedure, the damaged structure is healing and the patient will keep his own ligament. I’ve posted so many of these that it’s becoming commonplace to see these ACL tears heal without surgery. Because of these great results, we’re beginning to see other doctors attempt these procedures, which is great, but there are some things you need to keep in mind to ensure the best results.
Torn ACLs and Stem Cells
When we began wanting to treat ACL tears almost a decade ago, I knew that some physicians who used prolotherapy had been trying to inject this structure blind, without guidance. So once I had found a patient with a loose ACL due to a prior injury, I used one of our fluoroscopy machines to access the accuracy of this technique. I soon learned that trying to accurately inject an ACL without guidance (meaning just mapping out where you thought it should be on the skin and sticking the needle in) was like trying to hit the bull’s-eye of a dartboard on a moving truck from a highway overpass. The first five or ten times I tried it resulted in complete failure.
What could be so hard? The ACL can’t be “seen” on fluoroscopy; you can only see the landmarks of where it should be. We then tried ultrasound and found that while we could see one small part of the ligament, most of it couldn’t be visualized. Hence, it was back to the anatomy texts to see how to do this, and slowly over the next year, I became better and better at confirming that I was, in fact, injecting the ACL.
Fluoro vs. Ultrasound
Once I had begun to perfect a reliable way to inject this ligament, I taught it to my partner John Schultz, and along with another physician, we used both fluoroscopy (real-time X-ray) and ultrasound for the injections. For various reasons, we ultimately decided that fluoroscopy was better. If you’re interested in why, see my video below:
Our New ACL Patient
The patient above is a physician who had an ACL tear and was told he needed surgery. Instead, he opted for the procedure we pioneered that we now call Perc-ACLR for percutaneous ACL repair. He came in and had a bone marrow aspiration in the morning, and then we created high-dose bone marrow concentrate (a same-day stem cell procedure) and then injected that precisely into multiple parts of the torn ACL complex. For more on how that’s done, see the video below:
The MRIs above on the left are his preprocedure films, and on the right are films three months after the ACL procedure. They show nice healing, so this week he came in for a platelet booster shot. We expect this ligament to fully heal.
While these before and after MRIs showing great results and patients reporting that they can return back to full activities are common, the expertise needed to get these results is not trivial. Hence, I put together the top 5 things for patients to consider if they’re planning on getting this procedure:
- This procedure is very difficult to perform, and there is only one course in existence put together and approved by the inventors of the technique. Hence, if your doctor has not been trained and certified by the IOF to perform this procedure, find another doctor.
- This is generally not a procedure that can be done well with ultrasound imaging, so if your doctor doesn’t have fluoroscopy, find another doctor. See my video above.
- There is no reason for knee surgery to inject the ACL; that just adds risk. Instead, this can be done as a walk in/walk out procedure using a precise injection, no surgery required.
- Only about 70% of all ACL tears that get surgery can be healed this way, and only Regenexx providers have a Perc-ACLR candidacy tool to determine who is and isn’t a good candidate.
- A nurse in a chiropractor’s office using dead amniotic or umbilical cord “stem cells” can’t perform this procedure. In fact, he or she wouldn’t even qualify to take the course on how it’s performed.
The upshot? The Perc-ACLR procedure we developed is revolutionary in that about 70% of all patients who now get their ACL surgically yanked out and a tendon substitute surgically inserted can now skip this invasive procedure. However, this is a very difficult procedure to master, and there is only one course on earth that’s sanctioned by the inventors of the technique. Hence, if someone offers to inject stem cells into your ACL, please use the 5 tips above to decide whether it’s the real deal or if you should run out of their office.