Old Knees

It was a cold winter Saturday morning, and I head to the gym for my usual pickup basketball. I get there late and and was not able to warm up. We had next game. First play of the game, I get an outlet pass by the sideline and make a cut towards the basket. I drop to the floor in excruciating pain…POP! My knee starts to hurt as I recount this. As I drop to the floor, I close my eyes and I can visualize my knee popping.

Going to the doctor, I was hoping for the best, maybe a severe strain. As a precaution, she ordered x-rays first to check if there were any issues with my bones. As the x-rays came back negative, I was then sent to a physical therapist to do another evaluation. He literally asked me a few questions, barely touched my knee, and then referred me to get an MRI (which I should have done in the first place). The MRI showed a torn anterior cruciate ligament (ACL) and meniscus. Onto the orthopedic surgeon. He was able to provide me some options, where I decided to take tendons from my hamstring to repair my ACL. All in all, this process took 2 months from injury to actual surgery…something is seriously messed up with our healthcare system. This is timely to what is currently going on with the Trump administration trying to repeal Obamacare. Please don’t be stupid, just watch Last Week Tonight.

The ACL is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to the front of the tibia (shinbone).The ACL runs through a special notch in the femur called the intercondylar notch and attaches to a special area of the tibia called the tibial spine. I do not want to bore you with all the technical terms about the ACL, you can just look that up yourself, but the main purpose of the ACL prevents anterior (forward) movement of the tibia off of the femur, as well as hyperextension of the knee (a straightening movement that goes beyond the normal range of motion in the joint).

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There has been tremendous advancements in ACL procedures. When my dad got his ACL repaired 20+ years ago, the doctors had to cut open his entire knee and suture together the torn ends of the ACL. This has been shown to be unsuccessful, as there were a staggering amount of re-injuries. The current norm is ACL reconstruction using patellar tendon or hamstring tendon grafts. This is now done arthroscopically. Artificial grafts (LARS) can be used in certain circumstances and return to sport can be within a few months, however good quality evidence is lacking on this procedure, and many clinicians are concerned on the long term viability of the artificial graft.

So what can we expect next from ACL reconstruction? Feeling fearful of actual surgery, it would be a cool if there was something that wraps around your knee that magically repairs your injury, or just use a healing spell from Harry Potter.

Instead, something almost like magic, Dr. Martha Murray has been developing a new surgical technique that could revolutionize the management of ACL injuries. The Bridge-Enhanced ACL Repair (BEAR) surgery uses a sponge bridge to connect the two ends of a torn native ACL. A special protein infused sponge-bridge is placed in between the two torn ends of the torn ligament, and the sponge is injected with the patient’s own blood to create a clot and a healing scaffold. The surgeon draws the two ends of the torn graft into the sponge, and allows nature to take over and knit the ligament together naturally over time. If you’re finding that hard to visualize, here is the link to the video. Can I be a part of the phase 2 trial?!

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After speaking to numerous people who had their ACL reconstructed, I am feeling hopeful with my recovery. To help with my motivation during rehab, I will have 3 goals for the year after my surgery.

  1. Run a half marathon
  2. Squat 225 lbs.
  3. Have a 30 inch vertical leap.

 

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