UConn scientist working on a new way to repair knees

I also came across the following

UConn scientist working on a new way to repair knees via ctmirror

Aug 22, 2013

https://ctmirror.org/2013/08/22/uconn-scientist-working-new-way-repair-knees

There’s a clinical trial underway to test a new type of ligament Laurencin invented, which has already regenerated ACL tissue in animals. If successful, the next step would likely be a large clinical trial in the U.S. and seeking approval from the FDA to put the ligament into widespread use.

It’s part of the development of a field Laurencin calls regenerative engineering

Success of the surgery is often described in terms of how common it is for patients to return to sports; studies have offered varied pictures. Some have found 90% of patients return to sports 1 year after the surgery, others show the rate is closer to 50 - 70%.

In a patient with a torn ACL, the stump that remains contains a storehouse of nutrients and stemcells, which have the potential to grow into new tissue. Laurencin’s method involves using those cells and others that are already present, by placing a specially engineered “matrix” where the ligament should be. Cells can attach to it, creating new tissue.

“In many ways, we utilize the patient’s own body as a bioreactor, if you will, to be able to make the tissue,”

It took years to create the matrix, which had to have the right mechanical and chemical properties to allow for regeneration. Laurencin worked on it with James Cooper, a former PhD student now a prof at Rensselaer Polytechnic Institute in New York.  The matrix, the L-C Ligament, is named for Laurencin and Cooper.

Research in rabbits showed that the matrix could regenerate an ACL. For the past 2 years, it was studied in sheep. The clinical trial in humans began in the Netherlands in June.

The L-C Ligament is designed to provide support for the knee as soon as it’s implanted. It takes between a year and 18 months to fully regenerate an ACL, Laurencin said.

The device was recently patented; patent-holder is Soft Tissue Regeneration, a New Haven-based co. Laurencin co-founded. The co. has received funding from the state’s Connecticut Innovations, which gives the state a share of the co. 

MRI results wait time: 16 days

April 30, 2018

I received the following email:

“We have received your MRI results and Dr. _____ would like to see you back in the AKIC to go over those results on:

Wednesday, May 16th at 10:45am.  (16 day wait time)

We are happy to report that there are no urgent surgical findings in your #knee. Please continue with rehab exercises (ie. physiotherapy, athletic therapy, or home strengthening/flexibility program) and activities as tolerated.  Please remain in linear activity only (no pivoting or twisting) and no impact exercise (no running or jumping).

Please reply to this email confirming the above appointment”

To which I promptly replied:

“Are there any non-urgent surgical findings?

It really blows my mind I know 2 people who had MRI's scheduled, results provided and in 1 case surgery conducted in less than 2 weeks, and I have to wait over 2 weeks just to review them.  A phone call would be great to give me an idea of what's going on. 

Also wondering if I am better to have results sent to my previous sports medicine doctor in Toronto and fly their to speed receipt of diagnosis.  I understand from my healthcare background this is due to the medical care system setup, not individual people.  If you would like to reduce your turn around times, I would be happy to help.

As for your recommendation not to run or jump, I can barely walk.

Evening prior to MRI I stepped off a curb and bent my knee more than it wanted, and it has been quite challenging since then.
Confirming the appointment in half a month.”

The step off the curb 3 days prior brought the inflammation back to where it started. 

Received call from AKIC doctor at U Calgary next day, who provided some clarification.  Very grateful for this.

*even though the radiologist completed their report promptly, & the doctor received it, there’s still a 16 day wait time for results instead of scheduling them within 24 hours of actual availability.  Go back 4 & 7 posts to see examples how wait times are reduced with lean healthcare in the emergency room and MRI, which can be done

Total Wait Time so far for diagnosis: 40 days

Plus the additional 16 days now.

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.

Wait Time for Diagnosis

Thu Mar 22

Drop in to my Chiropractor. and they notice a few things seem out of the ordinary & request another ultrasound to check for thrombosis / DVT

Mon Mar 26

Acute Knee Injury Clinic at the University of Calgary responds 6 days after request regarding appointment, says to complete forms online & they are booked out for weeks, Apr.19 is next appt;

which means I won't receive a diagnosis for another 4 weeks.

How many injured people cannot wait 1 month & still achieve a positive outcome?

*Another example where lean healthcare can reduce wait times & improve patient outcomes.

another Chiropractor appt. today, worked on shoulder as it was sore from how I've had to adjust to get in & out of truck.

*also grateful to be somewhere that healthcare is at least available

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Thu Mar 27 - day 10

have DVT ultrasound appt identifying 3.8cm thrombus in 2 superficial veins of the popliteal trifurcation.  not sure where that is, feel free to tell us what popliteal trifucation means in comments.

Met family doctor, suggests some aspirin to help the body naturally disolve the clots, and to obtain a 2nd opinion from an orthopedic surgeon who should be available at the emergency.

head to Alberta Health Services Emergency

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How ACL Tear Occurred

Why I post this information:

Upon realizing Canadian orthopedics was 8 years behind current practices and unnecessarily removing ACL ligaments from patients clearly eligible to regrow them, I decided to make the information available to patients.

Here’s the start of how I found out orthopedic practitioners has not been informing people of their options, and in many cases do not even know themselves what is happening in their field.

Here’s the injury

March 17, 2018

Went skiing on backside of Lake Louise, marked where one gets off the lift, skied down and traversed

Top left shows where these pics were from with route there from front side

a couple pics of route marked & my friend making it up a steep

wide angle with route marked & on right you can see where the actual Lake Louise is & Fairmont hotel in relation to ski hill.

black line on right side shows route to this from back side; next pic is looking north

after travers, looking north (I think) from spot in previous pic

Where the previous pic taken from. Chateau Lake Louise in background. Not sure it bowl behind me goes to road or hike out needed - would like to know from someone who’s done it. Travers & skiing direction marked in green. video that wouldn’t upload here on my insta @ryancartiers

Not sure which of the 2 spines it was, recall the same curve marked in background to ski to ridge & drop in

on the way down after skiing 1st pitch, still up high, looking east I think. Snow was alright.

Found this pic online and only see 1 spine. Not sure where other is - looks like the curve though with face showing on either side below. Black is traverse, green is skiing.

Dropped in over shelf, landed ok - thought I was off but kept it together. Snow a bit cruddy. Caught left inside edge pulling the front of my ski out & behind me, bailed. Scramble to stop slide before rocks below. Had to use pole to undo binding. Couldn’t put enough pressure down left leg to lock into binding, so after a few tries picked up ski and slide across the steep below rocks on right side to reach flatter slope.

From pics pieced together this is my best guess where it happened.

Red is roughly the route out to make it onto the ski out.

1st pic friend took while waiting for me, just after fall, which was to the right of the rocks near the top right side of photo (outside of pic). Tried again to lock in binding, wasn’t happening. at 50% running 1 Nordica ski, knee hurt and still enjoying Lake Louise mountain life!

closer pic friend took while waiting for me.

trying to figure out if I need a month for this to heal and still ski May long weekend at Sunshine Village

…and skiing down to get onto ski out…

took a few breaks for the right leg heading down the ski out (route in next pic) - must have taken this photo on one of them. Told my friend to get a few more runs in when hit Paradise chairlift.

She had videos will post if we can find

Arrived at bottom for last chair (to get over to the front side). Liftees didn’t fuss about me keeping one ski in hand on the lift - much appreciated!

video that wouldn’t upload here on my insta @ryancartiers

off chair at top and over to gondola.    Ski patrol asked me if everything ok & liftee helps w skis - thank you

1st time I can recall downloading on a gondola when skiing an option.  For those who've never been here, sharing the view at Louise

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walking in ski boots doable, from gondola to front of Lake Louise lodge;  waiting for friend to get car and give me a lift to end of parking lot.  Great #view from here.

curious if getting boots off will be difficult, went ok.

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since this was my friend's 1st time in LakeLouise I said we should drop by Chateau LL

Was a slow walk to the front.

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stayed Deerlodge next to Chateau Lake Louise - took the evening pic while icing

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End of day March 17, 2018

Started icing Deerlodge - they have an outdoor deck w hot tub on top so its easy to sit in the snow on the side and #ice.

Stairs are less easy; manageable though.

sleeping was a challenge, finding a position not too painful long enough to fall asleep; seems like only a few hours Morning experience stiff & more painful.

I think it's just a sprain and may be able to recover for slushcup; friend has had a few ACL injuries in the US & typically sees the doctor, has an MRI next day, and surgery (if needed) within a week or so, starting recovery weeks from injury - I expect Canadian Healthcare to be at least comparable to US delivery whatever the diagnosis is. 

Guess what happened...