MDNews - Cleveland-Akron-Canton

+++++++++++++++++++++++++++++++++++++ + +++ +CLINICAL RESEARCH SPOTLIGHT U +++ +++++++++++++++++++++++++++++++++++++ Biologic Methods to Improve ACL Repair in Young Athletes at The Crystal Clinic A NTERIOR CRUCIATE LIGAMENT (ACL) injuries are on the rise in children. Paul R. Fleissner, MD, can testify to this. Dr. Fleissner is a pediatric and adolescent orthopedist at Crystal Clinic, Inc., in Akron, where he has practiced for more than two decades. PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON Paul R. Fleissner, MD, is a board-certified pediatric orthopedist affiliated with Crystal Clinic, Inc. Recently, he completed a pilot study with human patients in which he examined whether grafts enhanced with a collagen platelet-rich plasma in ACL reconstruction decrease the rehabilitation time and enhance revascularization and ligamentization of the graft, resulting in a lower failure rate as well as accelerated return to pre-injury level of activity. 28 | Cleveland/Akron/Canton MD NEWS I MDNEWS.COM I SEPTEMBER- OCTOBER 2013 "When I was a child, kids changed sports with the seasons, but that doesn't happen now," he says. "Because of society's infatuation with pro athletes, most children now choose at a very young age one sport that they play year-round. So we see a lot more overuse injuries in young athletes and quite a few ACL injuries." For the past several years, Dr. Fleissner has been conducting clinical research on ACL reconstruction outcomes, more specifically on biologic methods to improve graft healing and reduce rehabilitation time. The use of platelet-rich plasma (PRP) is one of those methods. While some studies have suggested that PRP is consistently effective in ACL reconstruction, others have shown no benefit at all. Dr. Fleissner explains: "Multiple studies have been undertaken to evaluate the efficacy of PRP in ACL reconstruction. Only one of the studies used any form of carrier to help deliver and maintain the PRP in the area. The results yielded a 40 percent increase in strength at six weeks, a significant difference from the untreated defects. In 2009 Spindler et al. showed significant correlations between platelet concentration and structural properties, such as maximum load and graft stiffness, and anterior-posterior laxity, when treating goats with grafts enhanced with a collagen-PRP composite (CPC). This concept seems logical because the collagen carrier can act as a delivery vector to maintain the growth factors from platelets at the surgical site. Otherwise, these growth factors may be degraded by some of the intra-articular enzymes." According to Dr. Fleissner, no study has reported on the effectiveness of the collagen matrix-PRP concept in a human clinical trial. Recently, he completed a pilot study with human patients, the results of which he hopes to publish later this year. In it, he examined whether a CPC in ACL reconstruction decreases the rehabilitation time and enhances revascularization and ligamentization of the graft, resulting in a lower failure rate as well as accelerated return to pre-injury level of activity. "This is something no one else in the country is doing right now," he says. "We are reconstructing ACLs in young people using biologics ... using some of the patient's own PRP with a collagen carrier. And we've had remarkable results." For his pilot study, 22 patients, 13 males and nine females aged 14 to 19, were enrolled. All but one incurred ACL injuries while participating in a sport. All patients had a diagnostic arthroscopy of the knee performed to evaluate the articular cartilage, menisci and anterior cruciate ligament. "Patients then had 52 milliliters of blood drawn off and combined with 8 milliliters of anticoagulant. It was then spun down under

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