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March 25, 2016

New ACL surgery could be a breakthrough

Daily Briefing

A new technique for repairing torn anterior cruciate ligaments (ACL) appears to be safe—and may offer a quicker path to recovery than the current approach, researchers announced Wednesday.

The ACL crosses the knee and helps provide stability, but is notoriously easy to injure, especially for athletes. There are approximately 400,000 ACL tears in the United States each year, according to the Boston Globe.

The typical surgical repair involves taking a tendon from somewhere else—such as the hamstring—and replacing the torn ACL. It's a complex operation, performed about 100,000 times annually, that requires drilling into the shin and thigh bones.

How to keep your knees young

But there may be a new approach: Bridge-Enhanced ACL Repair, which involves placing a sponge soaked in blood and special proteins between the torn ends of an ACL. Over the course of several weeks, the blood coagulates, and the torn ACL grows into the sponge, replacing it and reconnecting the two damaged ends of the ligament.

The idea of BEAR is to let the body heal itself, says Martha Murray, an orthopedic surgeon who is leading the development of the procedure.

Trial results

On Wednesday, doctors from Boston Children's Hospital announced the results of a phase 1 trial of BEAR, the first time the approach had been attempted on humans.

The trial featured 20 patients split between a control group, which received the standard procedure, and a second group that underwent BEAR surgery. Researchers reported that the 10 BEAR patients have ACLs that are now as strong as ACLs repaired through the traditional surgery.

What's more, there were no serious complications, and BEAR patients progressed through physical therapy more quickly than patients who underwent the traditional surgery.

Murray says the safety study showed it is possible for the "the ACL [to] regenerate and come back," adding, "I'm hoping that the BEAR will shift how people look at ACL surgery."

And Lyle Micheli, director of the Sports Medicine Division at Boston Children's, says he is hopeful the patients who undergo BEAR will have a lower risk for arthritis and other complications.


Experts say the new procedure is potentially a breakthrough, but stress that more research is needed. Jo Hannafin, an orthopedic surgeon at the Hospital for Special Surgery in New York, cautions that it will take as long as five years before the procedure can be evaluated, but adds that it is "definitely an advance."

Others praise BEAR as offering a less-invasive option to patients. "The real beauty of it is you are getting the native ACL to heal without having a graft," explains Rick Wright, a professor orthopedic surgery at Washington University School of Medicine in St. Louis.

Meanwhile, Murray is in the process of recruiting patients for a second, large study of BEAR. The study will be a double-blind controlled trail with 100 participants (Saint Louis, New York Times, 3/23; Springer, Boston Globe, 3/23; Futterman, Wall Street Journal, 3/23).

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