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Want to know how to avoid knee surgery to repair your anterior cruciate (ACL) ligament? Use the power of your own stem cells. Madeline skipped surgery for her complete ACL tear and instead had her own cells precisely and carefully injected into her torn ligament. Six months after her procedure she was back on skis tearing down a mountain at 60 miles an hour. How is that possible?

The ACL is a ligament in the middle of the knee that attaches at two different places. It prevents the forward motion of the tibia on the femur and also limits rotation of the tibia on the femur. From a practical perspective, this means that it provides stability to the knee.

When the ACL ligament is torn, it’s generally accepted that it doesn’t heal well on it’s own. Many times patients undergo ACL reconstruction, in which the old ligament is taken out and a piece of tendon is strung between two points to act as a substitute for the ligament. It’s not perfect, as the two functioning portions of the ligament generally are replaced with only one, and the artificial ligament goes in at a much steeper angle than the original equipment. In addition, removing one portion of the ligament means that the knee always will be more unstable in twisting or cutting movements.

Most patients don’t realize that there can be a number of problems with surgically replaced ACLs. First, with an auto-graft, the muscle the tendon graft is taken from never fully recovers its strength. Second, the operated knee never regains its normal position sense to guide normal landing. Finally, few patients ever return to their prior levels of activity, and two-thirds of young patients who undergo ACL surgery will develop osteoarthritis by the time they’re 30. In addition, the new surgically installed ACL ligament has no ability to sense stretch, so the knee loses its sense of position. Regenexx doctors often recommend that patients consider newer precise biologic injection options such as stem cells before agreeing to a surgical ACL replacement

Regenexx doctors pride themselves on transparency when it comes to results. They’re happy to talk about the patients that don’t respond at all or that respond partially. Madeline’s case is one that didn’t obtain a perfect result, but the final outcome was pretty good for her purposes.

Madeline tore her ACL in late summer and saw a surgeon who recommended an ACL reconstruction surgery. Regenexx doctors weren’t immediately sure that they could help. One band of Madeline’s ACL was torn in half and snapped back like a rubber band, and the other was hanging on by a thread. She also had an medial collateral ligament (MCL) injury to her knee and severe bone bruising with micro-fracturing of her tibia. In addition, Madeline was freaked out in general at the concept of an injection in her knee.

At the beginning of September, Madeline received a pre-injection to prepare her ACL ligament for the later injection. X-ray guidance was used to ensure that Madeline’s ligament was injected through and through. That was followed with a precise injection to place Madeline’s own stem cells from her bone marrow into the ligament. She wore a brace for a short recovery period before recieving an update shot with highly advanced platelet rich plasma (PRP) in December. At that time Madeline already was working out. By January and February, she began hiking and back-country skiing.

What did her MRIs show?

Madeline’s MRIs show her ACL before the injection, at three months after, and at six months after. The ligament looks ghost-like on the first image, and more robust and darker by the third. More importantly, her knee on exam is equally stable on both sides.

While Madeline appears to have complete healing on one of the main portions of her ACL, the other section, the one that was retracted back like a rubber band, never regenerated. Is that an issue? Madeline doesn’t think so, based on her activity level and ability to do anything she wants. The results are similar to those Madeline would have experienced had she had chosen surgery—except that she is using her own ligament, which maintains full position sense at a normal physiologic angle.

Madeline dodged the surgery bullet by using advanced interventional orthopedics techniques and her own stem cells. No ripped out ligaments or a year or more to get back to full activity. Madeline learned the easy way how to avoid ACL surgery and get back to doing what she loves.


“How to Avoid ACL Surgery” first appeared as a post on the Regenexx blog.
Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.