Healing Another ACL without Surgery

I’ve posted so many of these before and after ACL tear MRI images that I’ve literally lost count of the total. Meaning it’s become routine for us to help athletes who tear their ACL get back to what they love without surgery. We’ve got dozens of MRIs to prove that’s what’s happening. So let’s dig into this morning’s case.

ACL Tears

ACL stands for anterior cruciate ligament which is a major internal stabilizing ligament of the knee. It helps to keep the tibia from moving forward on the femur and to stabilize the tibia in rotation when you cut. When it’s torn and the patient can’t return to play, in the US it’s almost a 100% certainty that surgery to rip out the damaged ligament and install a tendon in its place will happen (ACL reconstruction). In Scandinavia, they take a different approach, often waiting 6 months to a year where many athletes get back to their sport without surgery, operating only on those patients who still can’t play by that point (1). Research has shown the Scandanavian approach to be superior or have similar results to the US early surgery approach, but this procedure is a major cash cow for US orthopedic practices and hospitals. So these surgeries continue here at a furious pace. Hence, many years ago we developed a precise x-ray guided technique to inject the ACL with autologous (from the patient) bone marrow concentrate to try to help patients avoid surgery by healing the ligament damage. That’s resulted in several published studies and an RCT just finishing up (2-4). That’s also resulted in me posting dozens of before and after MRIs on this blog showing healing of the ligament without surgery.

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Our Latest Patient

This is a 46 y male who tore his ACL while sparing in jiu-jitsu. He was already seeing Dr. Hyzy at our Colorado HQ who had successfully treated his shoulder and low back. He then saw an orthopedic surgeon who told him that he needed an ACL reconstruction, but knowing that he had already dodged the surgery bullet for his shoulder and back, he asked Dr. Hyzy to help. Our perc-ACLR procedure was performed as shown below:

By 3.5 months after the procedure, at a time when most ACL surgery patients are just starting physical therapy and aren’t permitted to run, he was jogging on a treadmill for a mile at a clip. At 4.5 months, when no surgical ACL patient would ever be permitted to return to play, he was cleared by Dr. Hyzy to return to jiu-jitsu sparring while wearing his brace. Basically, he recovered from the Perc-ACLR procedure twice as fast as the usual recovery from a surgical ACL reconstruction.

His images are above. The triangles point to the ACL. The ligament has a full-thickness tear in the top “Before” images and shows good healing in the “After” bottom images at 4.5 months.

Here’s a video with many of the before and after MRIs from the Perc-ACLR procedure:

The upshot? It’s great to see yet another patient aviod ACL surgery! We wish this patient many happy sparring matches!

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(1) Culvenor AG, Eckstein F, Wirth W, Lohmander LS, Frobell R. Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial. Br J Sports Med. 2019 Sep;53(18):1168-1173. doi: 10.1136/bjsports-2018-100167. Epub 2019 Feb 8. PMID: 30737199.

(2) Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;8:437–447. https://www.ncbi.nlm.nih.gov/pubmed/26261424

(3) Centeno C, Markle J, Dodson E, et al. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. https://www.ncbi.nlm.nih.gov/pubmed/30176875

(4) Centeno C, et al. IMAGE-GUIDED INJECTION OF ANTERIOR CRUCIATE LIGAMENT TEARS WITH AUTOLOGOUS BONE MARROW CONCENTRATE AND PLATELETS: MIDTERM ANALYSIS FROM A RANDOMIZED CONTROLLED TRIAL. Biologic Orthopedic Journal. DOI: 10.22374/boj.v3iSP2.24

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

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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