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ACL Research: A Q&A with Braden Fleming, PhD
In an effort to combat arthritis arising from anterior cruciate ligament (ACL) injuries, Braden Fleming, PhD and fellow researchers in the department of orthopedics at Rhode Island Hospital, are studying alternative treatments to the conventional ACL reconstruction. Fleming took some time to answer a few questions on the latest developments.
- Exactly what is an ACL injury and how does it happen?
The ACL prevents excessive motion between the shin and thigh bones.
85% of these injuries occur during activities that involve jumping, twisting and cutting without contact from another person (for example, soccer, basketball and gymnastics), while 15% of these injuries occur by direct contact with a person (for example, a "clipping" football injury).
ACL injuries can also occur when participating in the various activities of daily living.
- How common is this type of injury?
ACL injuries are extremely common; approximately 550,000 of them occur in the United States each year. This fact is particularly devastating when you consider that ACL-injured patients are then at a much higher risk for early arthritis.
Although they are prevalent in active men and women across all age groups, adolescent women are at the greatest risk for injury.
- What is the typical treatment?
Because the ACL does not readily heal, the current treatment for an active patient is to remove the injured ACL and replace it with a graft of tendon taken from another place in one's own body, or a cadaver. This surgical procedure is called ACL reconstruction.
Although it is an excellent operation for getting patients back to sports and activities, the odds of re-injuring the knee and the graft remain high after injury (particularly in adolescent patients) and it does not lessen the patient's risk for arthritis.
- What does this research show, and how will it benefit patients in the future?
Our lab has been seeking different ways to treat the ACL injury to restore knee function and eliminate the risk of early arthritis.
In a collaboration with Martha Murray, MD at Boston Children's Hospital, we have been developing a new technique to get the injured ACL to heal. We call this procedure bio-enhanced ACL repair. Our recent studies have shown that our bio-enhanced ACL repair restores knee function (at least to the level of the current standard of care, ACL reconstruction) and has the added benefit of reducing cartilage damage (arthritis). We are currently seeking approval from the FDA to test the procedure on patients.
- What should readers know about these injuries and your research?
For the past few decades doctors have treated patients with ACL reconstruction to restore the mechanical function of the knee. Although significant improvements have been made, early arthritis remains a concern.
Our research data suggest that new treatments should be designed to treat the inflammatory response to protect the cartilage after injury. Bio-enhanced ACL repair may be the way to accomplish this.