A new study has found a novel, non-surgical method that is very effective at healing a common sporting injury, rupture of the anterior cruciate ligament or ACL. The method could be a way to help sufferers avoid surgery altogether.
The ACL is a strong band of tissue that helps stabilize the knee joint. It’s one of two ligaments that cross the middle of the knee, connecting the thighbone (femur) to the shin bone (tibia). And it’s commonly ruptured during sports such as soccer, basketball, football, and downhill skiing that involve sudden stops, jumping, landing and direction changes.
According to a 2019 study, in the US alone, 250,000 individuals suffer an ACL rupture each year. Most undergo surgical reconstruction (ACLR) early or choose to have surgery after a period of non-surgical rehabilitation. Either way, surgery carries a risk of post-op complications, including pain, stiffness and decreased range of motion in the knee joint, joint instability, and stretching or rupturing of the graft used in the reconstruction.
Researchers from the University of Melbourne have now developed a new non-surgical protocol involving bracing and physical therapy that may improve healing after an ACL rupture and help avoid surgery altogether.
The researchers used their knowledge of the anatomy and physiology of the knee as a starting point. They know that the ACL has a rich blood supply and that the closer the ends of the torn ligament are, the smaller the gap needed to be bridged to allow reconnection.
Applying this knowledge, the researchers developed their novel cross-bracing protocol (CBP). They recruited 80 patients with acute ACL rupture between the ages of 10 and 58 and had them wear a brace that immobilized the injured knee at an angle of 90° for four weeks. During that time, they were required to wear the brace at all times, including during sleep and showering.
After four weeks, the knee’s range of motion was increased by adjusting the brace incrementally each week and physiotherapist-supervised rehabilitation, including muscle strengthening and functional training to enable a return to sports and recreational activities, was introduced. At week 10, the patients were allowed to undertake unrestricted range of motion, with the brace removed at 12 weeks.
On follow-up after week 12, the researchers performed magnetic resonance imaging (MRI) of the patient’s knees. They found that 90% showed evidence of ACL healing. That is, the ACL was continuous or reconnected. Healing at three months was associated with better knee function at 12 months, improved quality of life and a higher rate of return to sport.
The next step for researchers is to undertake longer-term follow-up and clinical trials to evaluate their novel treatment protocol.
“If the benefits of this treatment are supported by a clinical trial this could result in a paradigm shift, whereby people aim to heal a ruptured ACL rather than reconstruct it with surgery,” said Stephanie Filbay, lead author of the study. “We are now planning a clinical trial to assess whether this new treatment results in better outcomes than ACL surgery for acute ACL rupture.”
The study was published in the British Journal of Sports Medicine.
Source: University of Melbourne