Most football fans and athletes alike hate to hear the words knee injury or ACL injury. Most fear the worst when an athlete experiences a knee injury in practice and or a game.
The first known mention of an ACL injury occurs in an ancient Greek medical text where a wrestler was described as having lost knee stability following an injury in the ring. No repair or treatment information was reported. The first repair was reported in 1895 when an open surgical repair utilizing cat guts to reattach the torn ligament was described in medical journals, and the procedure remained essentially unchanged until the 1970’s.
However, because of significant risk to the patient in the forms of infection and permanent non repairable rupture and early onset of significant osteoarthritis, many athletes chose not to have any surgical repair and elected to rehab the knee and save surgical repair until their playing days were over. This explains the contention of Thurman Thomas that he played his entire career with a torn ACL.
The initial surgery had a failure rate in the 5 years following the surgery of over 60% so something had to be done. In the 1991 the first ACL reconstruction utilizing a tendon graft was reported. Initially, cadaver tissue was used for this repair and then the current standard of repair which is an autograft utilizing the patellar tendon or a piece of hamstring muscle from the athlete’s own body to reconstruct the ACL.
This type of repair was initially done as an open (large incision) but as arthroscopic surgery has come into its own, more and more ACL surgeries are being done arthroscopically. In addition with the improvement in imaging and a better understanding of the types of ACL tears that occur, better surgical procedures are being investigated in many places.
Alternatives for treatment are still needed because re-injury occurs at a greater than 30% rate and early onset osteoarthritis still occurs in over 50% of patients who have undergone an ACL repair, better treatment options are needed. Once of the issues with the knee ligaments in general and the ACL in particular is the limited blood flow to the ligaments which is further disrupted by the injury itself. Limited blood flow means getting necessary nutrients to the site of the repair by the body is difficult and causes poor surgical outcomes.
What this means is think of building a house, but because of where you live getting cement delivered for the house foundation is impossible because of the terrain won’t allow the cement truck to get to the foundation forms. As a result, you decided to mix the cement bag by bag in the back yard and pour the concrete yourself. A year after moving into your new house, the basement wall fails because the cement crumbled.
ACL treatment alternatives and adjuncts are on the forefront in many orthopedic teaching hospitals. Some current research currently being looked at is the use of synthetic material to provide a means to stabilize a repaired ACL internally. This research is in the early stages, however, given the recent problems with surgical mesh in other types of surgery, including the lawsuits that have been filed, more research needs to be done before this type of procedure goes into widespread use.
In addition, several studies on the use of platelet rich plasma, stem cell therapy, and bioscafolding are being investigated. While early results which much improved failure rates has been reported in the medical literature, a lot more research is needed on the current and future methods for repairing these injuries.
As long as athletes are getting ACL injuries, research will continue and hopefully soon, these type injuries will not be the Oh My God NO!!!! type injury they are today in the NFL, NCAAF and other professional sporting leagues.
Editor’s babble: Thanks to Dr. Beth Sullivan for keeping us up to date on the latest medical information pertinent to professional sports, especially NFL football. You can find Beth on Twitter @GAPeachPolymer.