TEAYS VALLEY, W.Va. — No single sinew in the human body is more notorious in the sports world — with the power to end an athlete's season in an instant — than the anterior cruciate ligament, commonly known as the ACL.
When that little strip inside the knee is ruptured, the standard return is about nine months post-surgery — a time dominated by tedious physical therapy and throbs of pain, baby steps back to the field of play. Even if they do return, it's estimated nearly 60% of athletes never return from an ACL injury with their former capability.
But a new procedure at Marshall Health may hold the potential for shortening recovery for ACL tears by months and with less pain — with sweeping ramifications for athletes and teams should future studies reinforce their early success.
Dubbed a "fertilized ACL" by the method's lead practitioner, Dr. Chad Lavender, the procedure injects a patient's own stem cells and bone graft into roughly 20-millimeter tunnels that surgeons drill into the tibia to reach the torn ligament inside the knee. An internal brace is strung over the damaged ACL and attached to bone to fortify the knee and hopefully quicken rehab.
By comparison, traditional ACL surgery typically requires a donor graft to replace the ligament, with small tunnels drilled into the bone above and below the knee to hold it in place.
Lavender has done the procedure over 30 times since Marshall Health developed it just over a year ago, and the results have been excitedly fruitful. The typical recovery time for the new procedure has instead been six to seven months, Lavender said, and patients have felt significantly less pain earlier in their rehab. The average patient pain score was 1.5 out of 10 at the two-week mark, and zero at six weeks — with many patients only taking painkillers immediately following surgery.
Lavender compared the new method with potting a plant, hence the "fertilized" term, with the mixture injected into the incision speeding recovery. Mixed to a putty-like consistency, the stem cell and bone graft mix is thought to protect the ACL grafts and increase vascularization by acting as a scaffold, while also speeding and bettering the graft's fusion to the bone.
"There are early advantages to fertilized ACL reconstruction, such as decreased pain," said Lavender, an assistant professor of orthopaedic surgery at the Marshall University Joan C. Edwards School of Medicine and lead author of the research. "And when this is combined with biologics, we may be able to accelerate rehabilitation and return to play more than previously anticipated."
So far it's proven safe with no increase in complication risk versus traditional ACL repair, but the operation is still under review — though Lavender's findings will be published for now a third time in a medical journal next month. The next step for Marshall Health to advance the technique would be to clear a three- to five-year clinical trial, which would call for around 100 local patients in the coming months.
"We're going to have to study this further for it to be implemented at a wide range, but the advantage here is that there is no increase in complication risk," Lavender said. "So that's going to make it more likely to catch on quick."
But as he flipped through the X-rays and MRIs from a handful of patients, Lavender already beamed with excitement as he recounted a handful of recovery stories.
The poster child for what a "fertilized ACL" could do became Reggie Jackson, an 18-year-old former St. Albans High School football player whose knee buckled and popped catching a screen pass against Nitro in September.
He wasn't medically cleared for the rest of the season, but the speed at which Jackson's abilities returned was astonishing. He walked at three weeks and jogged at five, he said over the phone Thursday. At eight weeks, he was playing pickup basketball, and at 10 weeks he could dunk again.
By that two-month marker, his ruptured knee was as strong or stronger than the operative one in all the tests they put him through, Lavender said.
Aaron Geething became a living comparison of the traditional versus the "fertilized" methods when he ruptured his ACL playing soccer in September. Three years earlier, the 36-year-old Charleston resident had torn the ACL in his other knee, which Lavender repaired then with the old technique.
But it was night and day comparing the two experiences, Geething recounted over the phone. His second recovery, with the new method, proved to be faster and less painful — requiring only one painkiller leaving the hospital followed by a few regular ibuprofen. That speed translated into his second round of physical therapy as well.
"That kind of confidence boost is what really gets people through their physical therapy," Geething said. "I was pushing them this time instead of them pushing me to do more reps or more weight."
For more information about the upcoming clinical trial, contact Marshall Orthopaedics at 304-691-1262.