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.

Encouraging Evidence in Support of ACL Preservation

Celebrating about a decade of advanced orthopedic treatment resulting in ACL tear regrowth and results. About a year ago I participate in this study to help contribute results.  

It’s amazing public health is still not offering this, and much of the the orthopedic community is a decade behind current practices.

I’m border line starting a petition for to get Alberta Health to stop unnecessary body part removal and protect orthopedic surgeons from a class action lawsuit from the 1100 or so patients a year receiving the wrong procedure.

Follow up MRI 1 - InternalBrace ACL Regrowth

Aug. 24, 2019 - 1 year, 3 months post surgery

Follow up MRI completed at Foothills Medical Center, Richmond Road Diagnostic, AHS, Calgary Alberta

Radiologist interpretation influenced by lack of exposure to this type of repair and therefore may not accurately reflect actual condition in tissue remodeling.

This is a general problem, despite ACL regrowth being practiced for 10 years most orthopedic surgeons are not practicing current method, and as a result radiologists do not have exposure they otherwise would have.

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.