New York Surgeon's Ground Breaking ACL Repair Approach Could Help 80,000 in US Alone
(3 months ago)
NEW YORK, Feb. 14: As many as 300,000 athletes and non-athletes suffer tears of the Anterior Cruciate Ligament (ACL) in the US annually.
The standard surgical treatment is ACL Reconstruction which requires an 8 - 12 month recovery period marked by a lengthy and often painful rehabilitation, significant atrophy, and often times the need for extended use of pain medication.
Additionally, arthritic complications can surface as early as 10 years after the procedure. The good news is that as many as 80,000 of those patients may be spared that long and painful road thanks to Dr. Gregory S. DiFelice of the Hospital of Special Surgery.
DiFelice's pioneering work indicates that a modern day approach to ACL Repair, a technique discounted decades ago for what was interpreted as only a 50% success rate, may be the preferred treatment for the right type of ACL tear.
DiFelice Determines Difference
The problem with the original data, as Dr. DiFelice noted and published on, was it lumped all ACL injuries together. By separating data by tear type, Dr. DiFelice determined why there was a difference in outcomes: Patients that tore the ligament from the bone, instead of in the middle, did well with ACL Repair surgery.
"In essence, the question should not be 'is the ligament torn?' but, 'how is it torn?' that determines whether ACL Repair is possible," explains DiFelice.
Modern Day ACL Repair
If ACL Repair is possible, patients are presented with a minimally invasive arthroscopic procedure that focuses on maintaining the patient's native tissue and avoiding the use of grafts. The procedure is shorter, less invasive, less painful, and offers fewer complications than Reconstruction. Because the patient regains their range of motion faster and has minimal atrophy, recovery time is dramatically reduced.
A majority of Dr. DiFelice's Repair patients have been documented to be off crutches and pain medication within one to two days and have full range of motion within one week after surgery. Many are able to run at four to six weeks post-operatively.
Dubbed "The Repair Guy" by patients and colleagues, DiFelice is committed to Ligament Preservation and a "less is more" approach that focuses first on Ligament Repair whenever possible. He has performed more than 150 Repairs and has published both two-year and five-year post-surgery data on his initial cohort validating the procedure's success. His first Repair patient is now 10 years post-surgery and still doing great. DiFelice is one of the world's leading authors on arthroscopic ACL Repair with more than 15 professional, peer-reviewed articles on the subject, and numerous book chapters.
International Collaboration Shedding Light on the "New" Approach
In addition to a fresh look at the data, and advances in diagnostic and rehabilitative medicine, Dr. DiFelice's international collaborations and at least one high profile case are helping to move the conversation forward.
While Dr. DiFelice started the conversation regarding modern day ACL Repair, several of his international colleagues have added their own interpretation, including Scotland's Dr. Gordon Mackay and French surgeon Dr. Bertrand Sonnery Cottet.
"The three of us have shared the podium at many professional conferences. In addition we all work closely with Arthrex, the worldwide leader in product development and Orthopedic Sports Medicine education," explains DiFelice.
"With Dr. Mackay's research regarding the addition of an Internal Brace to reinforce the repair; Dr. Cottet's research regarding Anterolateral Ligament (ALL) Repair and my work pioneering the new approach to ACL Repair, we have had the opportunity to confer, share findings and techniques and push the ball forward for the benefit of patients worldwide."
Conversations between DiFelice and Cottet included discussions on procedure modifications just prior to Cottet's ACL Repair on Slovakia's World Cup star, Veronika Velez Zuzulova. Her ACL Repair is being credited for what many are calling a miracle comeback keeping her 2018 Gold Medal hopes alive just 20 weeks after tearing her right ACL.
"We wish Zuzulova the best of luck, but, medal or no medal, the big picture is that her high-profile story is shedding light on the newly reinvigorated discussion regarding ACL Repair and the significant advantages it offers athletes at all levels," says DiFelice.
Keeping the Repair Option Open
Despite the mounting cases and supporting publications suggesting that, for the appropriate tear type, ACL Repair is the preferred treatment method, the shift away from the "Thou shall not repair the ACL" mindset—widely ascribed to by orthopaedic surgeons—has been slow.
"To keep all options open, athletes, parents and healthcare professionals need to take a closer look at ACL Repair," says DiFelice. This is especially important for younger athletes who have been shown to have high rates of re-injury and can develop significant arthritic changes as early as 10 years post-reconstruction.
"Anyone who suffers an ACL tear, has a loved one or coaches an athlete who has suffered such an injury should seek out a surgeon who offers an individualized approach to ACL surgery that includes the possibility of Repair."