MRI following primary repair of the anterior cruciate ligament

Primary repair of the anterior cruciate ligament (ACL) is being performed increasingly in the treatment of acute proximal ACL ruptures. Advantages of ACL repair over surgical reconstruction with a tendon graft include preservation of the anatomy and proprioceptive function of the native ACL, and therefore, faster rehabilitation. The addition of an internal brace protects the repair during ACL healing and can increase the success rate of the procedure.

Given this evolution of ACL surgical treatment, radiologists should be familiar with the new repair techniques and their appearances on postoperative imaging.

In this article, we describe two different surgical techniques for primary ACL repair, dynamic intraligamentary stabilisation and internal brace ligament augmentation, and provide an overview of the normal and abnormal appearances after this type of repair at magnetic resonance imaging (MRI) follow-up.

May 06, 2019

https://www.clinicalradiologyonline.net/article/S0009-9260%2819%2930157-6/fulltext

Although Canada is about a decade behind adopting current orthopedics with respect to these types regenerative medicine procedures, radiologists can prepare in advance. 

The Canadian radiologist who interpreted my regrown ACL MRI did so incorrectly, however when reviewed by those familiar with current procedures it was exactly the mottled appearance expected for that period of time.

Researching InternalBrace Ligament Augmentation for ACL Regrowth

One of the names I noticed on a few publications was Dr. Mackay at The Mackay Clinic, who it turns out pioneered the InternalBrace, and found the following:

“2 International Netball players have regained pre-injury levels of function 12 weeks after their ACL rupture has been treated with the internal brace.

“with the healing of their ACL confirmed by MRI. These exceptional outcomes are partly explained by the procedure’s preservation of nerve and blood supply and the avoidance of donor site problems thanks to the IB fixation, although the duration of recovery is also determined by the individual and the unique nature of their injury. The Internal Brace is quickly becoming a standard procedure in skiing and impact sports, especially in the USA,”

https://www.mackayclinic.co.uk/the-internal-brace-at-a-glance

I started looking up everything I could find on this, so I could talk about having it done here during my next appointment this week at AKIC with my sports medicine doctor at University of Calgary.

Side note related to stairs - I also recall a meeting to explore a possible Operations Manager position with a fast growing startup May 2nd.  They had stairs and I hoped they didn't ask me to walk up them to where the offices are – stairs were very difficult at this point – luckily we had it in the main area which was a nice change.  Still tried to make it less obvious.

ACL regrowth BEAR trials (bridge assisted ACL Repair)

After first finding an ACL healed itself, the 2nd thing I found were the BEAR trials run Boston Childrens in these two articles from 2016:

http://www.stack.com/a/radical-new-surgery-allows-you-to-regrow-your-acl 2016 stackmedia

https://www.bostonglobe.com/sports/2016/03/23/new-surgery-could-revolutionize-knee-repairs/BJISuh60AYKYTKWPwaYFWP/story.html Boston Globe

A safety study had been done on 10 patients, all reported “doing well, with knees working as well as knees treated with ACL reconstruction.”  The 1st patient surgery was Feb. 2015 (> 3 yrs ago), for Corey Peak, who also tore it skiing.  He concluded that it was a better option to treat a torn ACL; within 3 months post-surgery, his MRI showed that his ACL had started to naturally knit together; he was jogging on a treadmill. Soon after, cycling to work. 

Bridge Enhanced ACL Repair - How it works:

When viewed under a microscope, ACLs still have active cells and blood vessels after injury.  The ligament itself works hard to heal, however the synovial fluid — the lubricating substance that exists inside of all joints —washes away the blood clot that serves as the initial connection between torn tissue ends in other parts of the body. 

Conventional treatment for an ACL tear involves removing the torn ends of the ligament that’s trying to heal itself, & fabricating another from a tendon graft, usually done by stripping away good tissue (hamstring or patella).  Patients who had 1 injury then have to recover from 2 separate injuries—the torn ligament + the uninjured area where the graft was taken out.

Whereas a traditional reconstructions involves removing good tissue for a graft from another part of the body to fabricate an ACL, BEAR allows patients to re-grow their own ACL. This resulted in both quicker #recovery and fewer long-term complications than the traditional ACL amputation & reconstruction.

An estimated 150,000 ACL tears still occur every year in the USA. “ACL re-tear rate can be as high as 20% for teens.  Up to 80% of patients develop arthritis 15-20 years after surgery.”

Given the eligibility criteria timeline, I need to figure this out fast, as I was at 38 days, and I didn’t want unnecessary ligament removal.