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Am J Sports Med 2009;37:571-578.

Bone Marrow Stimulation Aids Repair of Incomplete ACL Tears

By David Douglas

NEW YORK (Reuters Health) Apr 24 - Primary anterior cruciate ligament (ACL) repair combined with bone marrow stimulation helps restore stability and function in youthful athletes with acute incomplete ACL tears, according to Italian researchers.

"Our technique," lead investigator Dr. Alberto Gobbi told Reuters Health, "avoids the use of the patient's own hamstring or patellar tendon to reconstruct the native ACL, eliminating harvest site morbidity. Our goal is to enhance natural healing processes to regenerate the partially torn ACL."

In the March issue of The American Journal of Sports Medicine, Dr. Gobbi and colleagues at Orthopaedic Arthroscopic Surgery International, Milan, observe that standard ACL reconstruction is the conventional method and has about an 80% success rate.

To determine whether ACL repair combined with bone marrow stimulation of the ACL femoral attachment might also be of value, the researchers employed the approach in 26 athletes, ranging in age from 17 to 37 years, with arthroscopically confirmed incomplete ACL proximal tears.

The repair procedure involved suturing of the tear and creation of small holes around the ACL femoral attachment, the idea being to facilitate release of mesenchymal stem cells from the bone marrow in order to promote healing.

All the patients then underwent a rehabilitation program involving passive motion machinery and other features similar to those of the Steadman protocol.

During follow up for a median of more than 2 years, Tegner scores, which were 7.1 before injury, fell to 3.5 following the injury and rose again to a level similar to that before the injury (6.7).

Only five patients (19%) did not return to the same level of sports activity. This was by choice in three patients. However, in the remaining two patients, there was a reduction in Tegner score of 2 or more points compared to pre-injury levels. They also had associated meniscal and chondral lesions.

Overall, there were significant improvements in other measures, including a reduction in Rolimeter side-to-side difference in anterior knee translation from 3.5 mm preoperatively to 1.3 mm postoperatively.

The approach provided satisfactory knee stability, and the researchers conclude that "Primary ACL repair can represent a possible alternative solution in young patients as this technique does not burn any bridge for future ACL reconstruction."

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