One of the real tragedies of our age is that we’re seeing younger and younger kids getting more and more invasive orthopedic surgeries. Why is that bad? Because we also see adults in their 30s with joint arthritis who were teens getting ACL surgery. Hence every teen we can save from this concerning teens and ACL surgery trend is a real win.
Houston, We Have a Girls’ ACL Problem…
ACL injuries in teen girls were uncommon 20 years ago. However, with more girls participating in high-level sports than ever before, we’re seeing an explosion in ACL tears. Why?
Girls have wider hips than boys, so when they jump and land, their pelvis forces their knees together. It’s this valgus force on the knee that can place the ACL at risk. Can this be corrected? Yes! For example, ACL injuries are uncommon among ballerinas because they don’t allow their knees to come in as they land.
Teens and ACL Surgery
Just how bad is the problem of teen girls and ACL injuries? This study of health insurance data for almost 150 million people found that, overall, the average annual ACL surgery rate jumped 22 percent from 2002 to 2014 (75 procedures for every 100,000 people). For teen girls, however, the annual ACL knee surgery rate skyrocketed by 59 percent to 269 procedures/100,000 people. We also know from another study that girls who can’t control their knees on landing are 15X as likely to injure their ACLs compared to girls who can.
While it seems like a really smart idea to get an ACL tear surgically fixed as fast as possible, recent data on this teens and ACL surgery trend doesn’t necessarily support aggressive surgery. For example, one study found that two-thirds of teens who get ACL surgery will have arthritis in that knee by the time they’re in their 30s.
Surgeons argue that this arthritis is due to the cartilage injury that happens at the time of the ACL tear. However, a recent randomized controlled trial out of Sweeden proved the surgeons wrong, as people who had early and aggressive surgery had twice the cartilage loss through the years as athletes who waited to see if they really needed an ACL surgery. In fact, 60% of those athletes never had the surgery and had half of the cartilage loss as a result. So there’s something about the procedure itself that’s likely causing arthritis.
The Regenexx Prec-ACLR Procedure
We were the first in the world to begin precisely injecting torn ACLs with stem cells. Since then we’ve published two studies on the process and teach the procedure to physicians from all over the world. We also named it Perc-ACLR, which stands for Percutaneous ACL-Repair. This is a demanding procedure to perform correctly. For example, watch my video below to see why using ultrasound instead of fluoroscopic guidance is often a bad idea:
What does the procedure look like in the procedure room? Watch my video below that shows Dr. Markle performing the perc-ACLR procedure:
A Teen Volleyball Athlete
In October of last year, Dr. Schultz first evaluated a 13-year-old female volleyball player who tore her ACL while landing on her knee that summer. She also had back pain, which he also assessed. Given the extent of the ACL tear (seen in the images on the left above), she was told that she was only a fair candidate for the perc-ACLR procedure. She was treated in October just as Dr. Markle demonstrates above.
The procedure began with a bone marrow aspiration. This in and of itself is highly specialized, as small volumes of marrow are taken from many sites to increase the number of stem cells harvested. This is quite different from other clinics that just take all the marrow from one or a few sites, decreasing its stem cell content. Our lab then created high-dose bone marrow concentrate (BMC) containing stem cells. Finally, Dr. Schultz used X-ray guidance to carefully inject both bands of the ACL at both ends to “paint” the ligament first with contrast, and then that was chased with the high-dose BMC. The patient was then braced, experiencing a recovery about twice as fat as the typical surgical ACL procedure.
She did well, returning to sports quickly, with the images on the right (at the top of the page) being five months out from the procedure. In those images, there’s clear evidence of a healing ACL without any tear. So with a little luck, she’ll avoid getting her own ACL ripped out and a tendon installed, or what we know as surgical ACL reconstruction.
The upshot? ACL injuries in teen girls are a huge problem. Operating on teenagers is likely a bad idea if it can be avoided. We help many teenagers every year stay away from ACL surgery with our perc-ACLR procedure.