ACL (Anterior Cruciate Ligament) sprains and tears are common and challenging injuries that cause knee pain and instability. The ACL is one of four vital ligaments that stabilize the knee during dynamic activities like running, jumping, and pivoting. When the ACL is injured, it can lead to knee pain, instability, and impaired movement. Traditionally, ACL tears have been treated surgically, but new research has shown that Bone Marrow Stem Cells (BMC) and Platelet-Rich Plasma (PRP) injections offer a non-surgical treatment of ACL tears with promising outcomes.

Understanding the ACL and ACL Injury

The ACL (Anterior Cruciate Ligament) connects the femur (thigh bone) to the tibia (shin bone) and helps control the forward and rotational movement of the knee. It contributes to the overall stability of the knee joint during dynamic activities. ACL injuries and tears affect the function of the knee, they are classified into three grades of severity:

  1. Grade 1: ACL is stretched but not torn, causing knee pain, swelling and some weakness.
  2. Grade 2: ACL has a partial tear, causing more knee pain and instability.
  3. Grade 3: Complete tear of the ACL, leading to significant knee instability and functional limitations.

With an estimated 200,000 ACL injuries and tears annually in the U.S., many of these cases require treatment, particularly in athletes looking to return to high-demand activities.

Standard ACL Treatment and Limitations

Conservative care with physical therapy or surgical ACL reconstruction has been the standard. However, surgery carries a re-tear rate of 10%-20%, especially in high-risk sports and when rehabilitation is insufficient (1). Additionally, untreated ACL sprains and tears are a major risk factor for developing knee osteoarthritis (OA). In fact, 20% of ACL-injured knees develop OA within a decade (2). Given these concerns, alternative treatments that promote ACL healing without surgery have been explored, leading to the use of Regenerative Medicine Treatments such as Stem Cells and PRP.

How Stem Cells and PRP can Treat ACL Injuries and Tears

Bone Marrow Concentrate (BMC) contains the patient’s very own mesenchymal stem cells (MSCs), which are known for their regenerative properties. Platelet-Rich Plasma (PRP), made from the patient’s blood, contains growth factors that stimulate healing. Precise injection of the BMC and PRP into the knee and specifically the injured ACL promotes tissue repair and regeneration in the ACL.

In a recent randomized controlled trial, 50 patients with knee pain and grade 2 and 3 ACL tears who did not respond to conservative therapy were divided into two groups:

  1. Exercise Therapy Group: Focused on strengthening the knee’s supporting muscles.
  2. Injection Group: Received precise image-guided injections of BMC and PRP directly into the ACL.

Patients in the exercise group could cross over to the injection treatment if they did not see improvement after three months.

Key Findings of the Study

The study results were highly promising for BMC and PRP as a non-surgical option for ACL injuries:

  • Pain Reduction: Pain scores decreased by over 50% at six months in the injection group, with continued improvement over the 24-month follow-up.
  • Functional Improvement: The injection group showed significant improvement in all measures of knee function at 6 months, with further improvement over the 24 month period.
  • Structural Healing: MRI scans showed structural improvements in the ACL, with signs of ligament healing and collagen fiber maturation.

These findings suggest that Bone Marrow Stem Cells and PRP injections can offer improved ACL tear healing, significant knee pain relief and functional improvement without the need for ACL surgery (3).

Comprehensive Treatment for ACL Tear

When treating ACL injuries with regenerative medicine, it’s crucial to consider the entire knee joint. In many knee injuries, often the other knee structures like the MCL, LCL, meniscus and supporting muscles and tendons are also affected. A comprehensive approach that treats all these structures maximizes the healing potential and return to function.

At Integrative Rehab Medicine, we specialize in advanced Regenerative Medicine Treatments in Estero, FL. We utilize image-guidance for all injections to ensure precise placement of the cells and we treat all the ligaments and supporting structures of the knee joint. Our comprehensive treatment plan also includes working closely with physical therapists to ensure proper rehabilitation during the healing process.

Schedule Your Consult with an Estero Knee Pain Specialist

Conclusion

For patients seeking a less invasive alternative to ACL surgery, Bone Marrow Stem Cells and PRP injections offer a promising solution for ACL sprains and tears. With proven knee pain reduction, functional improvement, and ligament healing, this therapy provides a viable option for those looking to avoid knee surgery while restoring their function and quality of life.

References:

  1. Crawford, S. Nicholas, MAJ Brian R. Waterman, and James H. Lubowitz. “Long-term failure of anterior cruciate ligament reconstruction.” Arthroscopy: The Journal of Arthroscopic & Related Surgery 29.9 (2013): 1566-1571.
  2. Barenius, Björn, et al. “Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial.” The American journal of sports medicine 42.5 (2014): 1049-1057.
  3. Centeno, Christopher, et al. “Image Guided Injection of Anterior Cruciate Ligament Tears with Autologous Bone Marrow Concentrate and Platelets: Midterm Analysis from A Randomized Controlled Trial.” Biologic Orthopedics Journal 3.SP2 (2021): e7-e20.