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Just had Healing Response technique done for partial ACL tear

post #1 of 30
Thread Starter 
I had posted a response on a thread for partial ACL tears and was urged by a fellow member to create a thread for the procedure so that it could be easily found.

For quick background...I tore my ACL and MCL off Granite Chief at Squaw. I was put under by my surgeon expecting to receive an ACL transplant but when I woke up he told me that he'd done a Healing Response procedure instead because it turned out I had a partial tear. The Healing Response is a technique developed at Steadman Hawkins. I'd never heard of the procedure before so I started researching and hitting the posting boards.

I've read everything I could find in the past few days which wasn't much. The theory behind the procedure is that the reason the ACL doesn't heal itself is that it has no blood supply so it can't clot, scab, and heal itself like an MCL can. Harvard wrote a paper on why ACL's don't heal themselves that jives very well with Steadman's approach. Only at Harvard they were proposing using collagen to generate the connection. Steadman uses stem cells from bone marrow. I could find no further information from Harvard so I have no idea if they've actually followed through with any procedures but it gave me more confidence to learn that another highly reputable institution was taking a very similar approach based on the same theory. Previously it was looking like only the Steadman-Hawkins clinic or doctors who studied there (like mine) were doing anything like this. I have run across quite a few OS's that think it's a useless procedure because it's performed on candidates who had a pretty decent chance of healing anyway so they thought that claiming success was suspect.

The Healing Response procedure mimics the way an MCL heals by creating and fusing a clot at the ACL tear using your own bone marrow (rich with stem cells) from your fimur. They perforate your fimur right at the ACL tear and the also perforate the tissue on the tear itself. Your bone marrow essentially bleeds into the gap and that's where the clot sits while you sit on your bum for 6 weeks. What happens is that the clot bonds to the tear and generates regrowth. Eventually the clot generates into a substance that is very similar to a ligament and is completely fused to your own ligament. Allegedly it makes as strong of a connection as using a ligament replacement because you keep your own connection....no bone plugs. There is a pretty good paper on what's happening at the cellular level on the Steadman-Hawkins research center site. I won't try to reiterate it as I'm scientifically challenged. It can only be done if the tear is at the very top of the ACL where the connection to the fimur is.

After reading about all of the other approaches it seems like some of the pros are that you only have 2 tiny scars because nothing is harvested or replaced. No secondary injury to heal. No used parts Also, while the first 6 weeks of recovery are hell for anyone used to being active, the overall length of the recovery is much shorter....no bone to fuse, no screws and so forth. It really is much less invasive. The glaring downside is that it is very new and controversial. From what I've found so far it looks as though it's probably only been done 5 or 600 times in the US. It does look like it's being performed in Switzerland quite a bit (I found that on someone's post but unfortunately it linked to an article written in German). The most famous case study was Bode Miller who had it done 8 months before taking 5th at Worlds.

My doctor is at Stanford Sports Medicine Clinic in Northern California but he trained under Steadman. I don't want to post his name because I think it's unfair. I do think he's an excellent surgeon who is obviously up on all the latest techniques. My incisions aren't even leaving any scars and my pain has been minimal. I stopped taking Vicoden at day 3 post op. He calls you personally the night after your surgery and he even goes to your first PT appointment to make sure that the transition from surgery to PT goes smoothly and all questions on therapy programs are answered. He probably does 6-8 knees a week and he does all his own surgeries unlike some of the big name OS's who have been around a long time. My only gripe is that I wish he'd educated me on the procedure before he went ahead and did it.

I'm probably over posting on a procedure that not many people will have but since I found very little information, I figured I'd try to contribute a lot so that the next person who google's "healing response" finds a few more posts and contacts. I'd also love to hear from anyone else who has had this procedure to see what your experience has been.
post #2 of 30
Interesting procedure MissMel, good luck with recovery!
post #3 of 30
Hope you can get back to the snow again.Good luck pal for the speedy recovery.
post #4 of 30

Question for MissMel

MissMel, thank you for the posting. It sounds like we've been in the same boat. I've looked high and low to find info on this procedure and have only found a study report from Steadman's. If I may ask...what were your postop instructions? Weight bearing / Non wt bearing? CPM? How long per day? When did you start your "active" PT? This procedure is being recommended for me and I'm wondering what to expect. Thank you ahead of time for answering.
post #5 of 30
I, too, have been wondering how you're doing, MissMel.

Is it feeling better all the time?
post #6 of 30

Maybe a candadate

Hi, i'm a patroller in the tahoe basin and hit a tree on the lateral side of my knee and thought i had the unhappy triad, ACL,MCL medial menisc etc.
Just had the MRI and the results show small femural condular fracture, partial acl tear and extensive bruising of the bone.
My ortho wants to do an arthroscope and if there is enough left on the ACL he wants to do the Healing response technique otherwise a full reco using the hamstring.
Anyone got more thoughts on the Healing response??
I could wake up with either so i'll let you know.
Cheers
post #7 of 30
There are some medical databases that are only searchable by subscribers; perhaps one of the Dr Bears here will have access and look it up for you.
I got some responses to my question about Morton's Neuroma that weren't available from regular Google.
post #8 of 30
I'm a little confused by the ACL replacement, and blood supply, as mentioned in the first post. I'm thinking that there is a little confusion here. You can correct me if I am wrong. I would be interested in knowing if there is a new ACL technique.

The ACL does have a blood supply. It is poor but it is there. The arterial supply comes from the middle geniculate artery (ACL). Dr. Steadman is a pioneer in cartilage regeneration (Microfracture Technique).
http://www.medscape.com/viewarticle/504936

Some history
http://www.knee1.com/hero/hero.cfm/19/1

This one is a good read.
http://www.medscape.com/viewarticle/474379_29

I would probably pick the hamstring tendon technique for ACL reconstruction if it were me.
http://www.medscape.com/viewarticle/474379_36

Dr. Stedman was/is the chief US ski team Doc.
post #9 of 30
I had read in another post on a different board that potentially the reason ACLs don't heal like MCLs is because they live inside the knee where they are bathed in a fluid that prevents the clot from forming that initiates the healing. There were studies on animals cited where a (collagen?) gel was used to form an artificial scaffolding to support the clot and allow natural ligament regeneration. This sounds a little different from your description, but along similar lines.

The ACL is alive and does have blood supply.
post #10 of 30
There is mention of Healing Response and Doc Steadman near the bottom of this page... http://www.skinet.com/article.jsp?ID...o ryID=0&adid=

Hammiegraft and meniscus repair for me in 12 days.....eieio
post #11 of 30
The best description I have found is on the Stedman Hawkins site.
http://www.shsmf.org/basicScience.asp
It sounds like the microfracture technique is used on the ACL, as well as underneath the surrounding cartilage.
post #12 of 30
My doc is a US snowboard team ortho and i've got a second opinion and i'll b getting the scope then going from there. It'll be a case of waking up with a cleaner knee, a repair or a hamstring graft.
Could have been worse. I have very little pain after 2 weeks and havn't the whole time aside from discomfort from swelling. Still have not experienced any instability and the lachmans has a definate end point. Not wearing a brace just icing and ace bandage.
Let you know.G
post #13 of 30

Hello MissMel,

Thank you for sharing.  Is it possible to update your result?  Funny I find this post after 5 years.  I just tore my ACL and have to decide my options.  I also leave in Northern Ca and very close to Stanford.  Were you happy with the doctor?  Do you recommend him/her?

 

I was very surprised how easy it was to tear an ACL.  For me it happened on a simple turn playing racquetball. 

Regards,

Fred

 

post #14 of 30

Good bump, interesting info, never knew about this.....hope I never have to make use of it though.

post #15 of 30

Yes, thanks for the bump - I'm glad I came across this thread.  I'm currently spending the weekend on the couch, awaiting MRI results.

post #16 of 30

Had this done (not at Steadman Hawkins) in 2006.  PM if you want information.  I can tell you what to look for as I had very poor results and had to have a second surgery for the complications.  It needs to be done correctly, both before and after the actual surgery.  This did not happen for me.  I had a complete ACL tear plus meniscus tear.

 

 


Edited by JaneB - 3/24/11 at 11:03am
post #17 of 30

Just had the healing response by Dr Steadman, a week ago.  Cpm machine was for a week.  Crutches for 2  brace for 6.  Wean off of crutches starting week 3.   I hear from the PT's at Head, that it has good results.  Let's hope thats true.

post #18 of 30

Not sure if this is the same thing I was told about having been done to one of my friends....looked back in my email and found:

 

Microfracture: The surgeon pokes or drills some tiny holes in the bone where cartilage is missing. The causes some bleeding which causes scar tissue or "sudo-cartilage" to form filling in the gap.

 

 

I'll check with her and find out how it turned out.  She had this done in 2009, so it's certainly been long enough to see the results....She subsequently had back problems, so she really hasn't been skiing that much for me to know the answer to the knee issue due to the back issue..

post #19 of 30

Thank you so much for the information. I will be having the healing response procedure on the 22 Dec 11. Your information is greatly appreciated and I will post any post op information for others to follow.

 

Thanks again!

 

Carlos

post #20 of 30

Could you give me your feedback? I will having the procedure on the 22 dec 11.

post #21 of 30

I think we need a whole section just for ACL banter.  Hope all above with ACL's are doing well and I would like to hear how all are doing.

 

 

post #22 of 30

Hi,

 

My doc recommended a healing response surgery for my complete acl tare.  I am interested to know how did it go for you?  Were you able to get back to normal sports/ski after the surgery?  any recommendation of the healing response vs. the normal reconstruction surgery?

 

thanks

G

post #23 of 30
Quote:
Originally Posted by giotto20 View Post

Hi,

 

My doc recommended a healing response surgery for my complete acl tare.  I am interested to know how did it go for you?  Were you able to get back to normal sports/ski after the surgery?  any recommendation of the healing response vs. the normal reconstruction surgery?

 

thanks

G

Hi G.  Welcome to EpicSki. 

This is an older thread, but I'm sure someone will chime in with some input .  

post #24 of 30

I had this done in 2004 for a complete ACL tear and meniscus.  Unfortunately, my surgeon did not train at Steadman Hawkins.  The pre and post-op care is just as critical as the surgery itself.  I wound up with very bad complications and a second surgery, this time by a Steadman-trained surgeon.  I am lucky to have found a wonderful website, Kneeguru.co   to help me find competent help.

 

PM me for more info., if you like.  You need a very consciencious and research-savvy surgeon, preferably at a teaching hospital, before you even think about this.  Done correctly, it's very promising. 

 

Jane

post #25 of 30
Hello everyone. I was surfing the 'net and came across this forum. I just had Healing Response surgery by the Steadman Hawkins Clinic and wanted to share a bit of my experience with you. It does seem that this procedure is still relatively new, and other than clinicals and reports, its hard to find patient information or feedback.

I tore my ACL the first full week of June. (I know, great way to start/end the summer, right?) I've played competitive sports my whole life (41 years old) and competed at some of the highest levels. I'd never had an knee injury until this happened, so when it gave out, I knew something was wrong. It did not hurt other than 30 seconds of initial burning, but it was obvious that it was unstable and I needed medical attention. I live close to the Steadman Hawkins Clinic in Greenwood Village, CO and had heard good things, so I scheduled and appointment. Through testing and an MRI, they quickly concluded that I had a complete tear of my ACL and damage to my MCL. I had surgery by Dr. Schlegel two months (yes months) later. On to the good part. smile.gif

The procedure was easy. I was in at 8:45 AM and I was home by 1pm. They had mentioned that based on their criteria and findings that I could be a good candidate for the Healing Response procedure (also known as microfracture) but I still had to sign forms authorizing a cadaver for the full ACL reconstruction. They also authorize numerous prescriptions to aid you post-op, such as Hydroco, Morphine, Naproxen, and something to aid my stomach in case this wicked Rx cocktail makes me sick. Nice.

I am 10 days post-op and I've already had two PT sessions. The first one was the day after the procedure and they are scheduled to be weekly for 6 weeks. After the first PT session, they changed the setting on my knee brace from locked out to 90 degrees flex. And at the 2nd appointment, I was able to flex to 135 degrees and I rode the stationary bike 2.5 miles or 13 minutes. I have only taken one Morphine tablet and that was the night of the surgery, just in case the local anesthesia block wore off and my state of bliss decided to divorce me.
I think there is a belief that you actually sit on your rump for weeks/months post-op and "wait for the clot to form." It is actually quite the opposite. I get a new list of chores each week from my therapist and to be honest, I have a hard time keeping up with all that is prescribed. The sutures were removed the day of my 2nd PT session, which helps as the taut skin during therapy was probably the most painful part to date.

I understand that Healing Response is not for everyone. They have a set of criteria that they adhere to and they don't fully know if it is right until they get inside your knee with the scope. They also found that I had a partial tear of the MCL while they were in there, which they also addressed. I am scheduled to get off my crutches next week at my appointment, and they said they will know in about 3 more weeks how well the surgery took as they can test for the presence of a reformed ligament.

My doctor stated that it has a very similar success rate as the ACL reconstruction (90%)+) and I am very optimistic. The hardest part is not getting overzealous and doing things that I shouldn't, like going to the driving range. wink.gif
post #26 of 30
I was recommended Steadman's healing response at an Austria sports clinic to repair torn ACL and meniscus, was told that they perform about 1000 Steadman procedures a year at that clinic. I had 48 hours post injury to make a decision so went ahead and did it - that was 10 months ago. They told me that the operation took 17 minutes!

However I came home with unclear post-op instructions so saw a physio for a few sessions and haven't really found anyone in the UK too familiar with Steadman post-op so did it on my own very slowly. No CPM machine which I didn't find out about until later.

Today it's still a bit stiffer than my other knee but I have regained full motion. I can squat and stay seated on my heels with no pain, I can kneel but it still hurt a little. Both legs equally strong.

I plan on going skiing for 10 days next week for the first time since the operation .

Will report back!
post #27 of 30
Well I am happy to report that 10 months and 10 days post ACL Steadman's healing op I got back on skis. Tried to wear a DonJoy brace but it was too cumbersome so I just used a neoprene over ski pants. I have gained 20lbs (of fat) since the operation which doesn't help but still managed 5 consecutive days without any knee pain at about 75% of capacity. No swelling, really nothing to report other than a bit of stiffness at night. One day I skied without the brace but it does give me a bit of extra comfort. Obviously a case by case basis but it definitely seems to have worked for me! Good luck everyone.
post #28 of 30

Wanted to share my recent ACL Tear and current  surprised status.  

 

Skiing on bivouac at Jackson Hole catching some small air and stuck the right ski in some hard avalanche control bomb blast.  My ski stuff like a knife in a cork.  I had clamped my bindings cause I was ejecting doing some huckin the day before.  Well, Bingo, ski did not release and did a 90 degree twist of right knee.   When I tried skiing on it it kept popping out and my femur would rotate around my tibia.

 

Went to clinic and they said I destroyed my knee and would need surgery.  They scheduled me for MRI and examination by local Ortho surgeon.    The radiologist and surgeon said I had a  High Degree Tear in ACl, and tear in MCL and small bucket tear in meniscus. I was shown my MRI and my ACL looked like an old towel snaking around with lazy turns.   The MRI appeared to be the classic  high degree tear.   I went on the internet and looked at 50  ACL MRI's and everything suggested a high degree tear.   Surgeon said if I wanted to ski at a high level I would need reconstruction surgery.  

 

Well,  I Am Here to say  they were WRONG about how to get back to shredding.   I chose to get PRP and bone marrow Stem Cell injections to regrow my ACL.  I went to a Doctor affiliated with the REGENEXX group out of Colorado.    The Crazy thing was when the Doctor injected colored die into my ACL to pinpoint the Stem Cell injections my ACL was straight and solid.  It looked almost normal.    Turns out the Doctor said my ACL had a  strain and was healing itself.  I am continuing with the StemCell injections to be sure it is nice and tight and my meniscus and MCL heal as fast as possible.

 

The surgeons want to cut you.  Don't jump too quick on this. I would have never known my ACL was healing itself, if I did not get the colored die injected into it.  I am now stoked to finish my Stem Cell Regenexx treatment and avoid  many months of professional PT.  I will of course work out myself on my bike and at the gym to get ready to shred Jackson next winter. 

post #29 of 30
Really ,livetuski?
Joined today, first post and it is an ad for regenex?
post #30 of 30

No other route offered to any of us excludes the surgeons knife.  Sorry if I sound excited or relieved but,  I AM.          I indicated the name because I figured some of you may want to know what procedure I decided to have.     Hey,   to each his own,  just relating My Experience.  There is no other motive but to share my experience.  Please do not think otherwise. thx

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