Long Term Effects of ACL Reconstruction Surgery: The Procedure Destroys the Normal Wiring of the Knee

By Chris Centeno, MD /

Receive a Regenexx® Patient Info Packet by email and learn why it's a superior regenerative solution.

long term effects of ACL reconstruction
I frequently look through the US National Library of Medicine for new research, and sometimes while I’m there, I chance upon old stuff that peaks my interest. Case in point today is a 2011 study that shows just how messed up ACL surgery is when it comes to the circuitry of the body. We all take for granted that our bodies are finely tuned machines and complex neural circuitry allows them to do the amazing things we’re designed to do. The study shows that these essential circuits are first messed up by the ACL injury and then by the long-term effects of ACL reconstruction surgery.

What We Know About the Long Term Effects of ACL Reconstruction Surgery to Date

Before I get into the ACL surgery side effects, let’s review what the ACL is. The anterior cruciate ligament (ACL) is one of four main ligaments that provide stability and precise motion to the knee. The ACL runs through the middle of the knee and attaches the bottom of the femur (the long upper-leg bone) to the top of the tibia (the larger lower-leg bone). The ACL is responsible for controlling front-back motion and rotation in the tibia, which stabilizes the knee.

The ACL can become torn or damaged, and these injuries are quite common in athletes, such as soccer and football players, and other active people who place intense forces on their knees. When the ACL is injured, this causes excess rotation and motion in the tibia and makes the knee unstable as shown in this brief video.

The conventional go-to treatment for a torn ACL is surgery to reconstruct the ligament. If you’ve followed this blog for any length of time, you know that ACL surgery side effects are numerous. We know, for example, the reconstructed knee never functions like it did originally because the mechanics of the knee are permanently altered following ACL surgery. Why? The ACL graft, the new ligament, is attached at a steeper angle, which can not only cause rotational instability in the knee but can also disrupt the normal sense of proper position.

Additional long-term effects of ACL reconstruction surgery include the fact that despite popular belief, knee arthritis is not prevented by undergoing ACL surgery, and, in fact, the operation may cause arthritis to set in sooner. Also either knee, the knee operated on or the opposite knee, has a six times greater chance of tearing following ACL surgery in active patients who return to sports after the surgery.

And just when we think we’ve encountered it all, another study showing still more long-term effects of ACL reconstruction surgery side pops onto our radar screen, like the one below.

How Does the Wiring of the Body Interact with a Ligament like the ACL?

The severe failings of modern orthopedic surgery are twofold: focusing on one body part and only considering its mechanics. I’ve blogged extensively on the fact that there is no such thing as a “knee.” There is a machine called the “spine-leg” that has a part that’s specialized that we could call “the knee.” So by making everyone think that the knee acts in isolation of its other parts, we’re doing a huge disservice to reality as the knee works in concert with the spine, hip, and ankle parts of that machine. The second major issue is that modern orthopedic surgery completely forgets about the wiring of the body. What do I mean?

We see all about us these days ever-sophisticated electromechanical devices. One that you may have seen is the complex of gears, joints, and levers that make up the machinery for stabilizing a camera. You can find these devices to stabilize your phone or a GoPro or on every mid-priced drone being sold with a camera. This serves to make the picture ultra-steady despite movement. These devices have been around for a long time, but they cost tens of thousands of dollars and are used only by professional movie photographers and your local news station filming from its chopper cam. Now they’re miniaturized and mass produced.

Let’s say this apparatus gets broken in some way so that it no longer works correctly to stabilize the camera. We know that there are two major categories that we need to consider to see why it’s not working: mechanical and electrical. The mechanical part is easy enough, as all we need to do is to inspect the gears, joints, and levers. However, if there’s nothing wrong there, we also know that there could be problems in the wiring or complicated circuitry that tells the device which position the camera is in relative to the ground and how to move to counteract that movement. However, for modern orthopedic surgery, it’s all about inspecting the gears, joints, and levers of the body, and there is no focus on the wiring and circuitry.

The paper I’m reviewing this morning concerns the wires and circuitry of the ACL. While the ligament has mechanical functions, like stabilizing two bones that make up the knee, it also has a large number of position sensors that provide information to the muscles of the leg on how to fire through a bit of wiring call the “gamma loop.” Think of this as like the sensors in the joints of the camera stabilization system that then tell the motors to adjust the position of the camera. Said another way, the sensors in the ACL tell the quadriceps muscle (the big one in the thigh) how much to fire and when. So a busted gamma loop means that the ACL isn’t coordinating muscle firing that in turn protects the knee by adjusting the overall joint position.

The Research on the ACL and the Gamma Loop

This 2011 study used a number of different modalities to measure the activity of the gamma loop in patients without an ACL tear, with an ACL tear, and with an ACL reconstruction. The researchers found that, not surprisingly, just tearing your ACL impacts this significant bit of neural wiring. This makes sense as the ACL has tiny position sensors that could be injured in the same trauma that tore the ligament. Also, loose ACL fibers won’t pull on the intact sensors the same way. Also, not surprisingly, they found even worse function of the gamma loop when the ACL was surgically reconstructed. Why? There is no way to hook up the thousands of microscopic position sensors in the tendon graft that serves as the new ACL so that the body can react to pulling on the artificial ligament.

The upshot? No matter how you cut it, ACL surgery is not a replacement of the original equipment but a 1980s attempt at replacing what was lost. What you get doesn’t function like what was there, which is one of the big reasons we push suitable ACL tear candidates toward ligament healing using our proprietary same-day stem cell injection. The goal there is to keep the mechanical function and wiring as intact as possible!

Leave a Reply

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

9 thoughts on “Long Term Effects of ACL Reconstruction Surgery: The Procedure Destroys the Normal Wiring of the Knee

  1. R. Bradley Reeves, M.D.

    Are there any level 1 or 2 studies comparing outcomes of ACLR vs stem cell treatments? could you supply those to me please.

    1. Chris Centeno Post author

      Brad, there are no such studies yet. However, we also have limited level 1 evidence for ACLR. We have a larger imaging case series that’s be submitted now and an ongoing RCT.

  2. Dom Costabile DO MS FAAFP RMSK

    Chris
    Thanks for sharing, I love your blogs as they improve my thinking and understanding of the many vignettes you share. I recently became aware that the origin of the word diagnosis stems from the root ” a way of seeing”. Far too often in the vast expanse of expanding medical information we stop at the term or ICD code, and stop thinking about antecedent factors, triggering events and modifying factors. Especially after a procedure or remedy. Our ability to repair and regenerate is a miracle all living organisms possess. We know so little of this marvel or nutrition which fuels the fundamental of this life process. Our name ,blame and attempt to tame ( pharmacutically or procedurally) tool box and mind set is so mideval in the context of 2016 bio molecular and biophysical knowledge. Thanks for helping me and you readers see anew and further upstream. Dom Costabile

  3. Natalie

    I was wondering what age this typically happens to, also if you could treat this without surgery.

    1. Regenexx Team

      Hi Natalie,
      It’s not something that happens at a particular age, it’s more about the individual surgery. Please see: https://regenexx.com/blog/acl-surgery-failure/ and https://regenexx.com/blog/new-acl-stem-cell-infographic/ Please let us know if you would like to set up an exam.

  4. Linda Reynolds

    I had major reconstructive surgery on my left knee in 1975 when I was 20. I am a female. A straight horizontal cut across my entire knee. I had torn the ligaments and collapsed playing basketball and was told I had subluxating patella in both knees. I did not let them operate the other knee as they wanted to because the left one has never been the same. 45 years later the knee is a mess and I have also re-injured it. Two ortho doctors said I needed a knee replacement. A third said I am not a candidate due to the damage the reconstructive surgery did. I am deeply discouraged; now the pain is not only in my knee but at times involves my shin, calf, ankle, etc. Would this stem cell therapy help an injury/damage like mine?

    1. Regenexx Team

      Hi Linda,
      We won’t know until we can do both a Candidacy Review and an exam. Do you have a recent MRI?

  5. Tommy

    If only the Stem Cell therapy is available worldwide =( I have a high Grade Partial tear and my surgeons wants to reconstruct my entire ACL 😢

    1. Regenexx Team

      Hi Tommy,
      We have a Regenexx provider in Taiwan, Province of China: https://regenexx.com/providers/chun-chuan-clinic/

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.