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ACL REPAIR: BEAR IMPLANT (NJ Sports Medicine Specialist)

ACL Repair was largely abandoned as a surgical option for the restoration of knee stability, function and return to sports and activity following an ACL tear or injury. This was due to a number of early studies showing poor results from suture repair techniques

Advances in surgical instruments and arthroscopic techniques, combined with a better understanding of the biologic determinants of ligament healing has led to a renewed interest in ACL repair has emerged. The BEAR implant is a device that adds to the potential to achieve and ACL repair. The implant provides a scaffold for ACL repair, a blot clot to stimulate healing and helps prevent synovial (joint) fluid from disrupting the repair process blocking the joint fluid from entering the edges of the torn ligament while healing occurs.

The video is a grand rounds I gave on the topic of ACL Repair utilizing the BEAR Implant. This is an informal but in my opinion informative look at new directions in the treatment of ACL injuries.

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The labrum of the shoulder is a thick cartilaginous ring of tissue that helps improve shoulder stability and overall function. Injury to the labrum can occur from a variety of causes, but is often associated with overhead repetitive use in sports like baseball, volleyball, swimming and tennis. The labrum is also frequently injured from trauma such as falls, car accidents and direct contact. Symptoms from labral injury to the shoulder can range from pain with activity to recurrent dislocations. Treatment of these injuries often involves physical therapy and progressive return to sports and activities based upon resolution of symptoms. When symptoms persist in spite of an adequate course of conservative care, surgery may be necessary to correct the problem. Below is a short video of a Type 2 SLAP repair performed arthroscopically.

ACL REPAIR

ACL tears are a common injury and being seen with greater frequency and at younger ages. Tears lead to loss of time from sport and activities and can lead to further joint deterioration without prompt recognition and treatment. The standard treatment is a reconstruction with autograft (patients tissue) or allograft (donor, cadaveric tissue). The choice of graft depends on several factors including age of patient and sports activity level. Currently, the time to return to sport has been shown to effect re-injury rates. Historically, 6 months after surgical reconstruction was considered an appropriate time to return to sports without restrictions. This notion has been challenged by recent studies noting lower re-injury rates by waiting 9 months or more to return to sports.

Newer surgical instruments and a retrospective look at studies from decades ago regarding primary repair have lead to resurgence in interest in primary repair instead of reconstruction. Failure rates have been high with this technique in previous studies that lead to the abandonment of this procedure. However, when evaluating the results or success of repair in specific tears, the results can approach that of a reconstruction. Specifically, proximal tears (from the femur) have better success when repaired. The advantage of a repair is that the ACL can be saved, less invasiveness and potentially faster return to sports. If the repair were to fail the standard options for reconstruction still exist. This is particularly attractive in pediatric patients where reconstruction techniques can injure growth plates.

Not every patient is a candidate but the option should be available for those patients inclined to have a repair over a reconstruction. I offer this to my patients who are appropriate candidates based on MRI appearance and surgical evaluation. Below is a short video demonstrating a repair I performed and the technique utilized.

Rotator Cuff Tears: What will happen if I choose to not repair it?

Without treatment, a rotator cuff injury can potentially worsen and progress over time. The rotator cuff is a group of muscles and tendons that surround the shoulder joint, providing stability and allowing for a wide range of motion. Injury to the rotator cuff can occur due to trauma, repetitive strain, or natural degeneration.

Initially, a rotator cuff injury may cause pain, weakness, and limited range of motion in the affected shoulder. Without appropriate treatment, such as rest, physical therapy, and possible surgical intervention, the condition may deteriorate. Here are some potential progressions of an untreated rotator cuff injury:

1. Tendinitis: A common initial stage of rotator cuff injury is tendinitis, which involves inflammation of the tendons. Overuse, repetitive motions, or aging can lead to tendon inflammation, causing pain and discomfort. Without rest and proper care, tendinitis can persist and worsen.
2. Rotator cuff impingement: If left untreated, tendinitis can progress to rotator cuff impingement. This occurs when the inflamed tendons become pinched between the bones of the shoulder joint, leading to increased pain and limited shoulder movement. Over time, the impingement can cause further damage to the rotator cuff tendons.
3. Rotator cuff tear: If the injury continues to progress without treatment, a partial or complete tear of the rotator cuff tendons may occur. This can happen gradually over time or due to sudden trauma. A tear can significantly impair shoulder function, causing persistent pain, weakness, and difficulty with daily activities and range of motion.
4. Shoulder instability: In some cases, a rotator cuff tear combined with untreated or unaddressed shoulder instability can lead to further complications. Shoulder instability refers to excessive movement or laxity of the shoulder joint, making it more prone to dislocation or subluxation (partial dislocation). The presence of a rotator cuff tear can exacerbate shoulder instability and increase the risk of recurrent dislocations.
5. Chronic pain and functional limitations: Without appropriate treatment, a progressing rotator cuff injury can lead to chronic pain and functional limitations. The shoulder may become increasingly weak, making it challenging to perform even simple tasks such as reaching overhead, lifting objects, or participating in sports and physical activities.

It’s important to note that the progression of a rotator cuff injury can vary from person to person, depending on the severity of the initial injury, individual factors, and the demands placed on the shoulder. Prompt medical evaluation and appropriate treatment can help prevent or mitigate the progression of a rotator cuff injury and improve the chances of recovery.