Healing-Response (or Microfracture) for ACL Repair
If anyone has any more information (good/bad), please share your experiences here. Seems like a great alternative to reconstruct an acl, w/o slicing up your own hamstrings, tendons, or dealing with the infection/rejection issues of a cadaver.
BODE MILLER: "HEALING RESPONSE"
AND THE COMEBACK KID
Editor’s Note: The following profile is based on an interview by Dick Needham. Mr. Needham is a senior contributing editor of Ski Magazine.
Call it coincidence, but it seems every time world-class athletes in need of a body repair visit Steadman-Hawkins – Bruce Smith, Dan Marino, Joe Montana, Phil Mahre, Steve Mahre, John Elway, Picabo Street, Greg Norman – they return to the playing field in better shape than when they were competing at even their highest level.
Witness Bode Miller. In 2000-2001, the soon-to-be ski racing phenom had already had one World Cup podium finish (giant slalom) and was primed for a big result at the combined downhill/slalom event in St. Anton, Austria. He was fourth in the slalom going into the downhill, but 30 seconds into the downhill course Bode hooked an edge at 80 miles an hour, careened off the course, and crashed into a fence. Result: a complete ACL tear of the left knee coupled with damage to the meniscus. Diagnosis: total ACL reconstruction, with an extended rehab period that such a surgery would require.
But something happened along the way. Dr. Steadman opted to use a revolutionary new procedure that he had developed. During Bode’s meniscus repair, he performed the “healing response.” This arthroscopic procedure involves making three to 10 small “microfracture” holes in the bone at the femoral origin of the injured ACL. The blood clot from the bleeding bone captures the injured end of the ACL and eventually reattaches the ligament back to the bone. The “healing response” has many advantages, including a much shorter recovery period and less cost, and because it is less invasive, the chances for osteoarthritis to set in later are greatly reduced.
Three weeks following his surgery, Bode was fully mobile and without need of a brace. Encouraged, Dr. Steadman suggested waiting another three weeks to determine whether the “healing response” would take. When the three weeks were up, the news was even more encouraging. “My ACL,” says Bode, “was re-growing entirely on its own.” By July, Bode was back on skis once again, training at Mt. Hood, Ore., and “feeling 100 percent, going right after it right away.” In the season’s first World Cub giant slalom in Solden, Austria, Bode finished a remarkable fifth – eight months after his surgery.
Bode’s new knee – and his determination to “go right after it” paid off big last season, with four World Cup victories, a second in the World Cup slalom standings, a fourth in the overall World Cup standings and two silver medals at the Salt Lake City Winter Olympics.
For most, those kinds of results would rank high in the memory bank. For the 25-year-old from Franconia, N.H., however, his most memorable moment was the day he made the U.S. Ski Team. Competing in the U.S. National Championships at Sugarloaf, Me., Bode came from 30th position in the slalom to capture third. “My family was there, all my classmates were there,” says Bode. “It was the greatest!”
When Bode isn’t on the course, he’s on the court. An all-state tennis player, he has been a coach and counselor at the family’s Tamarack Tennis Camp for years and, as this is written, is “just trying to relax and get the energy systems back up.”
“Tennis,” says Bode, “is a great mental exercise. It’s a longer event than ski racing and it helps you stay focused for a longer period of time.” But wait, there’s more. Golf, for example. A low- to mid-70’s shooter, Bode took up the game at 15 but didn’t “get serious” about golf until five years ago. “I really enjoy the game,” he says. “When I retire from ski racing, I’d like to play tournament golf—if I still have the competitive energy.”
Competitive energy isn’t something that Bode is likely to run out of anytime soon. The 2006 Winter Olympics are still ahead (“It’s a long way away, but I plan to be there”) and he’s already looking to compete in tournament tennis if he can bring in some major events locally (“It’s important for the kids to see their coaches compete”).
Besides, he always has the comfort of knowing that the staff at Steadman-Hawkins will be there to make sure the physical part is up to the energy part. “Dr. Steadman and his staff,” says Bode, “are the greatest—supportive and super friendly. It makes a nice environment to be in when you’re injured, bummed out and trying to keep your spirits up.”
The Steadman-Hawkins Sports Medicine Foundation is key to the medical breakthroughs that have brought athletes, like Bode Miller, back to their best. It provides the research environment in which important new procedures, like the “healing response”, are developed, nurtured, tracked and refined to promote top-of-the-game performance—for world-class competitors
What is the Healing Response Technique and when is it used?
The “Healing Response” technique was developed for the treatment of proximal tears, or tears close to the bone, of the anterior cruciate ligament. It is believed that these proximal tears heal better than mid-ACL tears because of increased blood supply close to the femur.
In the past, Dr. Steadman had placed sutures in proximal tears to hold the ligament against the femur. This proximity allowed healing to take place. Healing took place by blood flowing into the defect between the ligament and the femur. The blood subsequently formed a clot, then a scar and finally transforms into fibrous-type tissue, acting as a good substitute for the cruciate ligament.
During the past three years, Dr. Steadman and his staff have seen many different partial, proximal tears that did not need sutures because either one-half of the cruciate ligament was still attached, a small strand of ligament was still attached, or the synovium overlying the cruciate was still attached.
Because of this partial attachment, the ligament itself remained in close proximity to its insertion point on the femur, but was still functionally incompetent. For partial proximal ACL tears, Dr. Steadman developed the healing response technique. The surgical repair employs a tiny curved awl, similar to an angulated ice pick. It is placed through the notch and small bone fractures are made at the insertion site for the damaged ACL on the femor(DRAWING OF PICK). These fractures allow a blood clot to form in the space between the cruciate ligament and the bone. However, because of the partial attachment, sutures are not needed to maintain alignment.
Following the healing response surgical repair, we treat these cases as routine ACL reconstructions. Postoperative treatment and rehabilitation are almost identical.
What is the rehabilitation protocol for Healing Response?
Rehabilitation protocol from healing response is almost identical to a conventional ACL proximal repair, including physical therapy, bracing, hot/ice machines, continuous passive motion machine, hospital stay, anesthetic and medications.
What are the clinical findings for the Healing Response Technique?
Currently, we no longer view healing response as an experimental technique, but rather as a modification of an established procedure. Healing response patients regain knee function and show reduced knee laxity.
Currently, the Clinic has follow-up data on 442 patients who have had the healing response procedure. At an average of 42 months after surgery, data shows that 91% experience none to mild pain and 94% report normal to near normal knee function.
Wow I had not heard of that technique. Thanks for the info Ty. But it seems it can only be used in a few specific cases such as proimal end tears. Unfortunately midsubstance tears are more common. But this technique sounds great for folks "lucky" enough to have a proximal tear.
Yeah, I didn't realize it was only really useful for proximal tears until i found that second grouping of info.
According to Lunch, who had it performed here in SAC by a an orthopod who learned the technique under Steadman, the literature on this technique is literally just beginning to hit the journals and conferences.
Hmm, very interesting. The mention of sutures in there surprised me, I was always under the impression that those had been abandoned long ago as they were found ineffective. But sounds like their use is only for the proximal tears.
Despite having had both knees done, advances in medicine and the increasing frequency of these injuries (and surgeries) amongst the general population leaves me somewhat optimistic about the future of my knees. While I obviously don't want to screw anything else up, and will take every reasonable precaution to prevent it, it seems like they are developing more and more successful techniques to deal with injuries, arthritis, etc.