Issue link: https://viewer.e-digitaledition.com/i/155478
Torn ACL ACL immediately after reconstruction IMAGES COURTESY OF PAUL FLEISSNER, MD, CRYSTAL CLINIC, INC, AKRON an FDA protocol to isolate the platelet-rich plasma," he explained. "A standard single bundle quadruple graft ACL reconstruction was completed using autologous hamstring tendons. Of the 22 patients, five had a lateral meniscal repair, while five others underwent a partial lateral meniscectomy. There were no torn medial menisci and no significant chondral damage. After being saturated with PRP, a collagen carrier was applied to the tendons. The tendons were then anchored in the femur with a cortical button and by interference screw in the tibia, and the remaining PRP was applied to the graft and injected into each tunnel after the knee was drained." Postoperatively, the patients were placed in a cryocuff and hinged knee brace locked in extension. Six days later, they started physical rehabilitation following the MOON Protocol. Serial postoperative bilateral Lachman testing was done at three, six and 12 weeks and final follow-up. All patients were tested at final follow-up for a pivot shift phenomenon. Each patient was followed to completion of physical therapy (PT) — an average of 19 weeks. Once PT was completed, all patients underwent an MRI of the affected knee, and each patient was assessed with Lysholm and IKDC knee scores. Patient's current activity level was compared to their pre-injury status. "The reconstructed ACLs were evaluated at the proximal, middle and distal region. T2 images revealed a darker and thicker ligament appearing more like a posterior cruciate ligament. The surgically reconstructed ligaments were thought more homogenous in thickness and signal than the radiologist has typically seen in the past with standard ACL reconstructions. MRIs demonstrated no cases of tunnel enlargement on the femoral or tibial sides. Bony ingrowth evaluation showed excellent ingrowth on the femoral and tibial side. There was no case of circumferential incomplete ingrowth," Dr. Fleissner reports. All patients returned to competitive sports with no re-tear of their ACL reconstruction. Two patients suffered meniscal tears after they had returned to sports — a female while playing basketball six months after surgery, and a male while playing football eight months postoperatively. During surgical repair, each of these patients had a centrally located biopsy taken of the ACL graft midway between the femoral and tibial tunnels. In the female, biopsy revealed the outer two thirds of the graft was vascularized and viable, only the central one-third consisted of non-viable tendon. In the male, biopsy demonstrated complete vascularization of the graft and viable tendon throughout the entire specimen. "This study raises many questions regarding the potential benefits of a collagen-PRP composite in human ACL reconstructions leading to a shorter recovery time. I have performed over 200 ACL reconstructions using the CPC method to date and almost universally patients, therapists and colleagues have noticed a tremendous improvement in the outcomes of this surgery compared to other methods. This is why I am working hard to try to quantify and validate this method," says Dr. Fleissner. "Our next step will be to repair the ACL's anatomically instead of replacing them." For more information or to refer a patient, call Dr. Paul Fleissner at 330-668-4040. I ACL seven months after reconstruction