December 5, 2023

A new study has identified a novel, nonsurgical approach that is highly effective for treating common sports injuries and ruptured anterior cruciate ligaments or ACLs. The approach could be one way to help patients avoid surgery altogether.

The ACL is a strong band of tissue that helps stabilize the knee joint. It is one of two ligaments that run through the middle of the knee, connecting the thighbone (femur) to the shinbone (shin bone). It typically breaks down during sports such as football, basketball, rugby, and alpine skiing that involve sudden stops, jumps, landings, and changes in direction.

according to a Study in 2019In the United States alone, 250,000 people suffer ACL ruptures each year. Most people undergo surgical reconstruction (ACLR) early on or opt for surgery after a period of non-surgical recovery. Either way, surgery carries the risk of postoperative complications, including knee pain, stiffness and reduced range of motion, joint instability, and stretching or rupture of the grafts used in the reconstruction.

Researchers at the University of Melbourne have now developed a new non-surgical treatment option involving bracing and physical therapy that could improve healing after a ruptured ACL and help avoid surgery altogether.

The researchers started with knowledge of the anatomy and physiology of the knee. 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 that needs to be bridged to reconnect.

Applying this knowledge, the researchers developed their novel cross-bracing protocol (CBP). They recruited 80 patients with acute ACL ruptures, aged 10 to 58, and had them wear a brace that immobilized the injured knee at a 90° angle for four weeks. During this time, they were asked to wear the brace at all times, including while sleeping and bathing.

After four weeks, the knee’s range of motion was increased with weekly incremental adjustments to the brace and physical therapist-supervised rehabilitation was introduced, including muscle strengthening and functional training, to enable return to sports and recreational activities. At week 10, the patient was able to perform unrestricted activities, and the brace was removed at week 12.

At a follow-up visit after week 12, the researchers performed magnetic resonance imaging (MRI) of the patients’ knees. They found that 90% of patients showed signs of ACL healing. That is, ACLs are contiguous or reconnected. Healing at three months was associated with improved knee function, improved quality of life, and a higher rate of return to sport at 12 months.

The next step for the researchers is to conduct longer-term follow-up and clinical trials to evaluate their new treatment options.

“If clinical trials support the benefits of this treatment, it could lead to a paradigm shift where the goal is to heal a ruptured ACL rather than surgically rebuild it,” said Stephanie Filbay, lead author of the study. “We are now planning A clinical trial to assess whether this new therapy leads to better outcomes than ACL surgery for acute ACL rupture.”

The study was published in British Journal of Sports Medicine.

source: University of Melbourne