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Torn Knee Ligament: Can It Be Healed?

New Technique May Some Day Allow Torn ACL to Be Healed, Not Just Replaced
By
WebMD Health News
Reviewed by Louise Chang, MD

March 24, 2006 -- A torn ACL in the knee can be replaced -- but it can't be healed. A new technique now shows promise to change this.

Doctors long ago gave up trying to repair a torn ACL (anterior cruciate ligament). That's because the important knee ligament, essential for running and jumping and keeping the knee stable, almost never heals right. A new technique may overcome the ACL's famous reluctance to heal.

The idea is to promote healing by building a kind of bridge to connect the two halves of a torn ACL. The bridge keeps fluids in the knee from washing away repair cells, says orthopaedic surgeon Martha M. Murray, MD, head of the sports medicine research lab at Children's Hospital in Boston.

"The repair cells are looking for a place to go and heal, but they get lost in the fluid," Murray says. "We developed a collagen bridge to give the cells a place to crawl into and be happy and functionally heal. With this bridge, the cells just go crazy. We found that to be incredibly exciting."

While the technique is exciting, it's still experimental. Murray's team is still experimenting in animals. Human tests are years away. Why? It's still not clear how well the healing works. If the ACL doesn't heal back to full strength, it could suddenly give way.

Lonnie Paulos, MD, professor of orthopaedic surgery and co-director of the sports medicine program at Baylor College of Medicine, Houston, applauds the researchers' effort.

"It is a good project," Paulos tells WebMD. "I just bet it is a long way off. If I were a betting man, I'd bet we don't see it in my lifetime."

Murray and colleagues report their findings in the April issue of the Journal of Orthopaedic Research.

Torn ACL: Current, Future Options

The ACL is the big ligament that keeps your knee stable as you run and jump. Athletes sometimes suffer a torn ACL. It's one of the worst sports injuries. That's because unlike other torn ligaments, the ACL won't completely heal.

"The ACL does heal. The problem is, it does not heal under the proper tension," Paulos says. "What was once a high-tension cable is now a piece of spaghetti."

Murray and Paulos note that doctors used to try to repair the ACL by stitching it back together. That didn't work very well. After a year or two, the ACL would rupture again.

So doctors gave up on trying to repair a torn ACL. Instead, they took it out and replaced it. Paulos says the first choice for replacement is tendon from another part of the patient's leg. The second choice is using tendon from a deceased organ donor.

Surgeons now have learned to do this operation using arthroscopic techniques, which require only small incisions. Even so, it's a big operation. About six months are needed for recovery.

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