Does a Torn ACL Require Surgery?

by Chris Centeno, MD /

does a torn acl require surgery

Does a torn ACL require surgery? Not according to these before and after MRIs showing ACL healing that are now getting pretty routine around our clinic. Orthopedic surgeons aren’t happy about it all, as ACL reconstruction surgery is like a sacred cow crossing the road in India—it’s the one procedure that defines modern orthopedic sports medicine. Based on what we’re seeing every day in the clinic, most of these invasive surgeries should be replaced by precise stem cell injections.

Lydia’s Story

Lydia is an active 14-year-old high-school student who plays volleyball. She had a ski injury in December with a subsequent reinjury of her knee while performing jump squats in volleyball. Her knee MRI showed a complete ACL tear. Treatment consisted of a brace and physical therapy, and she was told she would need an ACL reconstruction surgery. In February, Dr. Schultz performed the precise image-guided placement of her own stem cells into the ligament, using our patented same-day injection procedure (without surgery). Above is her three-month postinjection MRI. On the left the MRI shows few visible ACL fibers (yellow arrows), and on the right it shows an ACL that now has some substance (yellow arrows) but still needs additional work.

Where Should Lydia Go from Here for the Best Chance of Fully Healing This ACL?

First, based on our extensive experience with stem-cell-based ACL healing, we know the following:

  1. Lydia’s ACL was a challenge to start with in that there were fewer visible fibers than in our typical stem-cell-treated complete ACL tears.
  2. At her age, it’s often possible to see complete healing at three months (which doesn’t generally happen in older patients as quickly).

So we know, based on experience, that this three-month result needs more work if she’s going to end up with a robust ligament. Hence Dr. Schultz advised her to get a second procedure. How many patients need a second full stem cell procedure or other injection to help healing? About one in three at this point.

So does a torn ACL require surgery? We now have many, many before and after MRIs showing imaging progression of torn ACLs toward healing after the ACL stem cell procedure we invented (many images are on this blog). We’re seeing even more MRI evidence of ACL healing now that we have again advanced our stem cell placement techniques. Hence, the prima facie evidence we see every day argues that most ACL surgery will soon be a thing of the past, relegated to the dustbin of medical history. When will that happen? Given that we now have allowed a nonprofit to begin teaching other physicians this advanced ACL stem cell technique, hopefully sooner rather than later.

The upshot? ACL surgical reconstruction will likely end up being an interesting point on the timeline of the history of orthopedics. A place where medical students 50 years hence look back and say, “What were they thinking?” To them the question of “Does a torn ACL require surgery?” will be as ridiculous to us as “Does an infection require bloodletting?” Why? Even the ACL tears we can’t heal today with this technique will likely be fixed in the future through a small needle, using advanced biologic techniques to regrow the ligament and not arthroscopic surgery to drill holes and install a tendon!

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6 thoughts on “Does a Torn ACL Require Surgery?

  1. Dennis

    I just read a news report that said per new “guidelines,” weight-loss surgery should become a more routine treatment option for diabetes. These guidelines were endorsed by interested and affected groups (such as the American Diabetes Association). Does this mean this surgery will be covered by more insurance companies (if they currently aren’t), and more generally and broadly, is this how insurance companies are nudged to start paying for newer procedures and medical advances? Of course, I’m thinking about how this weight-loss surgery example may generally apply to orthopedic stem cell procedures that insurance companies (shortsightedly IMO) currently do not cover.

    1. Regenexx Team Post author

      Dennis,
      It’s a interesting case, and we’ll need to wait and see. The difference however, is that weight loss surgery is within the current paradigm of medicine. The surgical paradigm which solves problems (actually creates others) by surgically adding or removing things. There is a reason a person would become obese enough to qualify for weight loss surgery. Neither Lapbands, nor stapling nor surgically removing part of the stomach address the cause, they address the symptom. Same thing in orthopedics. A locking knee is a symptom. It occurs when the popliteus muscle doesn’t pull the meniscus out of the way of the femur in time. But rather than addressing the cause, current standard treatment is to whack out a chunk of the meniscus. http://www.regenexx.com/knee-locking-up/ So while we hope interventional orthopedics will follow because it is a logical step, it’s a step requiring a huge paradigm leap.

  2. Kelli

    Has Lydia undergone an additional round of injections, and if so, do the results suggest further regeneration? What would be the recommended timing for a second procedure in the adult knee under similar circumstances?

    1. Regenexx Team Post author

      Kelli,

      About 1 in 3 of these patients get a second procedure. The timing is of course based on progress of the individual patient.

  3. REBECCA MORGAN

    I understand this result is in a teenager, where the fibres are able to rejoin in young adults? I am 32 years of age with a full ruptured ACL. I am very physically fit and wish to return to surfing. I believe in this technology, though at 32 I am searching for more data in my age category. With a person returning to extreme sports such as a skier, gymnast or surfer.

    Do you have any cases you can send me?

    Thank you Bec.

    1. Regenexx Team Post author

      Bec,

      Your ability to respond is definitely not diminished at 32! Our Pro Athletes are treated with anominity, but here are a few case studies of people we can talk about: https://regenexx.com/results/live-patient-outcomes/knee-outcomes/ (gymnast) http://www.regenexx.com/acl-stem-cell-injection-procedure/ https://regenexx.com/blog/acl-tear-avoid-surgery/ http://www.regenexx.com/blog/knee-acl-stem-cell/ http://www.regenexx.com/blog/knee-acl-surgery-alternative/

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.
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