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What is Fertilized ACL Reconstruction Surgery?

Fertilized ACL (anterior cruciate ligament) is a new technique that utilizes a combination of bone marrow concentrate, autograft bone, and demineralized bone matrix to fill the tunnels within the knee joint during the standard ACL reconstruction surgery for ACL tears. This technique also uses a new concept of an internal brace to reinforce the ACL and boost the stability of the healing ACL.

In general, an athlete requires about 9 months to return to sports after a standard ACL reconstruction. Even if they do return, it is estimated almost 60% of athletes never get back to their former competence level. However, a fertilized ACL reconstruction technique for ACL tears is believed to shorten the recovery time by months and with reduced pain, thereby allowing athletes to return to their full capacity and sports in less time (about 6 months) without any functional limitations.

Anatomy of the ACL

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction to correct the abnormality.

Indications for Fertilized ACL Reconstruction Surgery

An ACL tear or injury is the main indication for fertilized ACL reconstruction surgery. An ACL injury most commonly occurs during sports that involve twisting or overextending of your knee. An ACL can be injured in several ways, including:

  • Sudden directional change while running
  • Sudden slowing down while running
  • Landing incorrectly from a jump
  • Direct blow to the side of your knee, such as during a football tackle

When you injure your ACL, you might hear a loud "pop" sound and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction. 

Preparation for Fertilized ACL Reconstruction Surgery

In general, preparation for fertilized ACL reconstruction surgery will involve the following steps:

  • A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
  • You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You should arrange for someone to drive you home after surgery.
  • A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Fertilized ACL Reconstruction Surgery

Anterior cruciate ligament reconstruction is a surgical procedure to replace the torn ACL with part of a tissue graft taken from your leg (autograft) or a donor (allograft).

Fertilized ACL reconstruction surgery is performed under general anesthesia with a minimally invasive arthroscopic technique. In general, the procedure involves the following steps:

  • Your surgeon will make two to three small cuts, about 1/4-inch-long, around your knee.
  • An arthroscope is inserted into the knee joint through one of the incisions.
  • An arthroscope is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end that is connected to an external monitor and enables your surgeon to view the inside of the knee joint.
  • Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
  • The torn ACL will be removed using miniature surgical instruments passed through the other incisions and the pathway for the new ACL graft is prepared.
  • Small holes are drilled into the upper and lower leg bones (femur and tibia) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft.
  • The graft is pulled through the predrilled holes in the femur and tibia and fixed into the bones with screws or suture anchors. 
  • Your surgeon now injects “fertilized ACL” which is a mixture of the patient's own special cells obtained from bone marrow concentrate, demineralized bone matrix, and bone autograft into the tunnels. This mixture helps to facilitate rapid healing of the ACL graft. An internal brace is also utilized over the ACL to stabilize the knee.
  • The scope and the instruments are withdrawn, and the incisions are sutured and bandaged.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after fertilized ACL reconstruction surgery will involve the following:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
  • You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed to address these.
  • You are advised to keep your leg elevated while resting to prevent swelling and pain.
  • You will be given assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities is recommended.
  • An individualized physical therapy protocol will be designed to help strengthen the knee muscles and optimize knee function.
  • You will be able to resume your normal daily activities in a month or two, but with certain activity restrictions. Return to sports may take around 4 to 6 months.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Fertilized ACL Reconstruction Surgery

Some of the benefits of fertilized ACL reconstruction surgery over traditional ACL reconstruction surgery include:

  • Shorter recovery time
  • Significantly reduced pain
  • Faster return to sports

Risks and Complications

Some of the risks and complications of fertilized ACL reconstruction surgery include:

  • Numbness
  • Infection
  • Pain
  • Adverse reactions to anesthesia
  • Blood clots or deep vein thrombosis
  • Damage to adjacent soft tissue structures
  • Decreased range of motion
  • Re-rupture of the graft