Dr. Tim Wang, MD, orthopedic surgeon at the Scripps Clinic is San Diego, California, talks about a new marshmallow-like implant that repairs ACL tears.
Interview conducted by Ivanhoe Broadcast News in July 2022.
Are ACL tears are super common?
WANG: ACL tears are one of the most common knee injuries that we see. They occur quite frequently in sports, in particular sports that involve a lot of cutting and pivoting maneuvers such as basketball, football, and soccer, and can lead to a pretty significant pain and miss time for a patient and an athlete.
Has there been any changes to how you treat this for about three decades?
WANG: Yeah. The standard of care for ACL reconstruction of what we’ve been doing for many decades is what’s called an ACL reconstruction or removing the ACL that’s torn and then reconstructing it or rebuilding a new ACL, either from tissue, from the patients knee, their own knee, other tissue or using cadaver ligament or a cadaver tissue.
Is recovery is very long and difficult?
WANG: Yeah, the recovery challenges include having a second incision for us to borrow some of the tissue either from the patellar tendon or the hamstring or sometimes even the quadriceps. Patients get a little bit of weakness from there, as well as the time required to rehabilitate and increase muscle strength after that surgery and operation.
Now you are using a new technique that heals it from the inside?
WANG: Yeah, we are really excited about this new technique. It’s called the BEAR procedure, bridge enhanced ACL restoration. This is one of the first time so we’re able to repair somebody’s own ACL and support it as it heals with a collagen sponge to help it form into a healthy ACL again.
How does it work?
WANG: One of the unique things about injuries within a joint- within the knee is that there are different enzymes and chemicals that can break down the initial clot and healing of any sort of tissue. This implant helps support that clot and the initial scar tissue that previously we weren’t able to generate to allow for that healing inside.
How do you implant it too?
WANG: The procedure is done arthroscopically, so first thing we always take a look with our little microscope or arthroscope, taking a look at the ACL as well as the other structures of the knee such as of the- such as the cartilage and the meniscus to make sure that’s okay. We then assess the ACL to make sure that the quality is sufficient, that there’s enough tissue for us to sew. Finally we plan to sew the ACL back together and through a small- so that’s all done arthroscopically. Then we use a small incision to help deliver this little collagen sponge, it’s about the size of a marshmallow, and we soak it and load it with the patient’s own blood and insert that into the knee through a small incision and wrap that around the repair site.
Is the recovery time faster then?
WANG: Recovery is faster for this procedure in the sense that we don’t need to make a second incision to harvest or borrow tissue from the patient and the time required to rehabilitate that lost muscle strength thereafter.
Do you have specifics on time length?
WANG: Yes. The benefits include relatively shorter surgical time by about 30 minutes or so. In addition, there is a potential for shorter healing time and overall recovery for sport, but we’re still looking into that right now.
How was Jenna when you first met her?
WANG: Jenna was really the ideal patient for this procedure because she was motivated, she’s active. I think she had an interest in the cutting edge and the new and for physicians in this space, one we are excited about these new procedures. We also want to be relatively careful when we do these and make sure we’re still being safe. Jenna was somebody that had done a lot of research before, she understood the pros and cons and the potential upsides to this procedure and was fully bought into both the rehabilitation process, recovery processes, as well as any things that may come up during the surgical process. I think she had done a litany of research already before. She was interested in this BEAR procedure. Here at Scripps we are the only site to do this procedure and we met and discussed it and she had received some consultations from other surgeons. Then she and I also talked about this specific procedure as well as the standard of care and the pros and cons of each and then of course, letting her make the ultimate decision of which way she wanted to proceed.
How many ACL tears do you see in a day, a week?
WANG: We see a lot of ACL tears here. Probably in an office day we probably see between five and 10 ACL tears. On any given surgical day, we’re doing maybe three ACL surgeries per day in addition to some of the other things that we’re doing. Again, it’s a testament to how frequent these injuries are and quite frankly, how successful our standard of care is too in terms of returning patients and athletes back to the activities that they love.
Who is a great candidate and who is a bad candidate for this?
WANG: Patients eligible for this procedure have to be at least 14 years old and the injury has to be relatively acute, which by that we mean the time from injury to surgery we’re shooting for roughly around 50 days. In addition, anatomic factors that we look at are the quality of the ACL and then it has to be strong enough to hold that stitch as well. It also has to be a complete tear of the ACL.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Stephen Carpowich
Carpowich.stephen@scrippshealth.org
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