ACL Repair for Young, Active Patients: Heightened Risks Create Opportunity for Regenerative Technologies
BY LAUREN UZDIENSKI, JULY 16, 2008
Researchers at the Mississippi Sports Medicine and Orthopaedic Center have found a failure rate nearing 24% for ACL reconstruction in young, athletic patients, according to a new study. Of 61 patients aged 15-39 who underwent ACL reconstruction, 14 were deemed failures at two years (23.4%.) In contrast, the Center previously found a failure rate of less than 3% in patients over 40 years of age.
As the ACL treatment population becomes younger and more diverse, it is clear there is a need for a more durable implant. Right now, however, there are few alternatives available.
Autograft is tissue collected from the patient's hamstring or patellar tendon and used to reconstruct the ACL. This option comes with the risk of donor-site pain and morbidity and may not be an option for some patients.
There are a number of synthetic ligaments on the market; Corin offers the Ligament Augmentation and Reconstruction System (LARS); Surgicraft has the composite (carbon and polyester) ABC Ligament and Telos Medical markets the Trevira Ligament. However, though synthetic products are free from the supply concerns that surround allograft, they have historically been shown to have a high failure rate.
Xenograft tissue is another alternative, though it has also been associated with failure and an inflammatory response in humans.
Tissue regeneration represents another opportunity for treatment, though the technology is in a nascent state. Serica Technologies is developing a silk-derived synthetic ACL, SeriACL that has shown evidence of regenerating the ligament in animal studies. The use of poly-L-lactic acid (PLLA) in a tissue-engineered scaffold has also demonstrated encouraging structural and mechanical properties in early studies.
