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This will be a short blog this morning as I have to travel this morning. However, something that never gets old is seeing the amazing results of our Perc-ACLR procedure. Let’s dig into this morning’s example.

What is Perc-ACLR?

Perc-ACLR means “Percutaneous ACL Repair”. This is a procedure where we precisely inject a high dose of the patient’s own stem cells into the torn knee ACL ligament by using precise x-ray guidance to map out the ligament. Check out how that’s done below:

This procedure can now help about 70% of the patients who would normally get ACL surgery. In that more invasive procedure, the ACL is ripped out, tunnels are drilled, and a tendon is strung to replace the damaged ligament. The problems with that procedure are:

• The tendon that’s strung goes in at a different angle than the original equipment
• The surgery itself causes a second hit to the cartilage and doesn’t prevent arthritis
• The knee has less position sense since those sensors are ripped out with the torn ACL

This Morning’s Result

This is a 25-year-old patient who is from overseas who was playing soccer and ruptured his ACL ligament. His MRI results are above.

The ACL in the “Before” image is delineated by the yellow arrows. The ligament in front of those arrows is light-colored and “blown out” (bigger). That’s a complete ACL tear that should require surgery. The post-Perc-ACLR images are to the right (labeled “7-months After”). In those images, the yellow arrows point to a darker, dense, and more normal-looking ACL ligament.

I spoke to the patient yesterday and we reviewed these images. He’s back to running and playing soccer. Since he still has mild discomfort with cutting activities and I can’t easily perform a hands-on exam of his ligament, I recommended that we set him up with a local Regenexx provider (he’s now on the US east coast for work) for a quick PRP (platelet-rich plasma) booster injection into the ligament. That procedure will be full activity and shouldn’t change his work out regime much.

In fact, if not for the pandemic and if this patient was local here in Colorado, I would have expected that the above MRI would have been taken at month 3-4 and that a booster shot would have been applied at that time so that by month 6 he would be back to full activity. However, that’s just the way things are right now.

The upshot? The Perc-ACLR procedure never ceases to amaze me. Our randomized controlled trial for Perc-ACLR is done and now we’re just waiting for all patients to move through that protocol. In the meantime, after reviewing dozens of before and after Perc-ACLR MRI’s and having spoken to as many or more patients, the results are game-changing. Which is why I added the above challenge to my surgical colleagues ripping out ACL ligaments: “Why again are we operating on these patients?”

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