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W ITH AN EVER-INCREASING number of children and adolescents playing sports year round, there has been a significant increase in the number of injuries to the anterior cruciate ligament (ACL). There is constant research being conducted to improve ACL surgical outcomes. Over the years, there have been significant gains in the treatment of ACL tears, including graft placement, surgical instrumentation and technique, as well as rehabilitation of the athlete. However, there continues to be a percentage of patients who fail the surgery or develop early arthritis in their knee in spite of a successful surgery. Past research has focused on better bony ingrowth, revascularization and ligamentization of the graft by the use of biologics, including platelet rich plasma (PRP) and a collagen carrier. While these strategies have met with great success, there are still some patients who develop early arthritis in the knee, despite a stable knee. Current thoughts believe this may be due to the lack of propriocep- tive (position sense) nerve fibers in the reconstructed ligament. This has led to the next stage in the process of treating ACL injuries — primary repair, which has met with limited success in the past. Review of previous research on the primary repair of ACL tears reveals that there were significant limitations. Every tear was repaired through a large incision, and postoperative rehabilitation involved prolonged immobilization, which is no longer considered healthy for the joint. It is now realized through extensive animal research that the ACL contains propriocep- tive nerve fibers, which are very important for joint stability and health. Animal studies have shown that repair leads to marked reduction in arthritis compared to standard ACL reconstruction. This led to current research, which involves the use of biologics and an arthroscopic technique that limits damage to the joint and promotes healing of the torn ACL. A new technique, called Flash Fix, involves the use of a collagen–PRP composite in the reconstruction or repair of the ACL. Not all ACL tears are repairable, but when pos- sible, this is now the treatment of choice. Forty-six primary repairs of the ACL have already been performed with promising results. Patients are experiencing much less postoperative atrophy and completing physical therapy much sooner than the standard reconstruction. Primary objectives in the treatment of ACL tears are joint stability and long-term health of the joint, meaning prevention of early arthritis. Primary repair of the ACL appears to be the best chance of accomplishing this goal. To achieve this goal, utilization of the Flash Fix technique with PRP and a collagen carrier, along with an arthroscopic technique, provides a reproducible method which allows the torn ACL a good chance to heal. The added benefit of this procedure is that no bridges are burned. If the ACL does not heal, the patient still has all of their tissues available for a standard reconstruction, and if it heals, none of their tissues have been violated, and they have all of their proprioceptive fibers intact. The potential impact of this procedure on the overall health of the knee is tremendous, considering the number of ACLs which are torn each year. The Flash Fix technique holds the potential to revolutionize the future treatment of ACL tears. Dr. Fleissner is a board-certified orthopedic surgeon practicing with Crystal Clinic in Akron, Medina, and Green, Ohio. He developed the Flash Fix technique for ACL reconstruction and repair. ■ Flash Fix by Paul R. Fleissner Jr, MD +++++++++++++++++++++++++++++++++++++ + +++ + +++ +++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: ORTHOPEDICS❯ 1 8 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ M AY/J U N E 2 0 1 5