The next report I came across really put the it into perspective the need for alternatives given complications and lower than toted outcomes of ACL reconstruction, and how InternalBrace initially measured up within the first 3 months – back in 2015.
Anterior Cruciate Ligament Repair Revisited. Preliminary Results of Primary Repair with Internal Brace Ligament Augmentation: A Case Series
“estimates suggest that in the United States alone 400,000 ACL reconstructions are carried out each year. As the majority of ACL injuries occur in patients of working age, the economic burden to both patients and society is considerable”
“ACL reconstruction. The technique either involves removing or bypassing residual ACL tissue, without any attempt to repair the ligament”
“In the majority of cases, sufficient tissue remains for a repair to be considered, particularly if surgery is carried out within 6 weeks of injury”
*What really strikes me – perhaps from my continuous improvement background – is removal & reconstruction is a work around to the problem*
“A number of problems have been identified with ACL removal however, with autograft harvest associated with a degree of morbidity from tissue loss. Hamstring muscle weakness following harvesting averages 10% in most studies with anterior knee pain common with patellar tendon grafts”
“loss of proprioception a particular problem. Not surprisingly therefore the majority of studies of gait after ACL reconstruction show abnormal gait patterns and altered knee kinematics which may be linked to the higher rate of early Osteoarthritis”
Orthopedic & Muscular System: Current Research ISSN:2161-0533
“68 consecutive patients who underwent Anterior Cruciate Ligament repair with IBLA were followed for a minimum of 1 year following #surgery … between Sept 2011 and Sept 2014”
“Only patients who had completed one year of follow-up were included … max time from injury to surgery was increased to 3 months”
*I’m within this time frame, & receiving a diagnosis that will not facilitate a successful outcome*
“Beyond this time the ACL remnant begins to remodel and retract, and the tissue is no longer able to be placed back at its original attachment point”
“Loss of proprioception is important as it may lead to overloading of the ACL graft ... It is estimated that less than 50% of patients return to sport after reconstruction, and those that do often find that they cannot perform at the same level as pre-injury/pre-surgery”
“The majority of studies assessing gait and knee kinematics post-ACL reconstruction show an improvement in gait pattern compared to pre-surgery, but compensatory mechanisms of muscle use persist in the majority of patients indicating sub-optimal performance of the reconstructed graft. Graft donor site morbidity from tissue loss and scarring is well documented with hamstring weakness and anterior knee pain problematic after hamstring and patellar tendon harvesting respectively”
“modifications introduced to the ACL reconstruction technique to try to improve outcomes include: changes in graft tunnel position, double bundle rather than single bundle grafts, retention of the ACL remnant and variations in graft fixation techniques.
NONE of these modifications have been shown to make a significant difference to patient reported outcomes.”
*Earlier return to function could result in less hospitalisation and healthcare usage post-operatively, with an earlier return to work and sport. This could potentially have benefits not only to the patient but to the health service and society as a whole.
the time to surgery in patients undergoing acute ACL repair with IBLA is likely to be shorter than those undergoing ACL removals, the majority of whom will have failed a period of conservative care.