Anterior Cruciate Ligament (ACL) injury | Research & Clinical Trials

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We understand that an ACL injury can devastate young athletes. Our team of orthopedic surgeons, sports medicine physicians and injury-prevention specialists continues to work toward improving ACL treatment.  

A clinical trial focused on bridge-enhanced ACL repair (BEAR), a less invasive approach to ACL surgery, launched in 2016 and may shift the model from reconstructing the torn ACL to repairing the injury.

Our surgeons’ earlier research resulted in pioneering physeal-sparing and transphyseal ACL reconstruction surgeries for young athletes. Our ACL Program also focuses on developing new approaches to ACL injury prevention in collaboration with experts at The Micheli Center for Sports Injury Prevention.

Bridge-enhanced (TM) ACL repair

Bridge-enhanced ACL repair (BEAR) at Boston Children's Hospital

Research led by Boston Children’s orthopedic surgeon Martha Murray, MD, focuses on stimulating the healing of tissues inside joints — particularly the ACL and meniscus of the knee.

Treating these injuries remains one of the most challenging problems facing orthopedic surgeons, since damaged ACL ligaments have almost no ability to repair or regenerate. Surgery is typically performed to remove the injured tissue and replace it with a tendon graft. But even with this procedure, patients have a high risk of developing premature arthritis in the knee after an ACL tear (as high as 80 percent 14 years after an ACL tear). In addition, the current surgery requires taking a graft of tendon, so the knee has to recover from that part of the procedure as well.

This technique — bridge-enhanced (TM) ACL  repair — uses stitches and a bridging scaffold (bio-engineered sponge) to stimulate healing of the original ligament and allow the torn ACL tissue to regenerate rather than replacing the ACL with the tendon graft. The bridging scaffold is placed between the two torn ends of the ligament and provides a medium for the cells to come back into and heal. The less invasive technique requires just two incisions, in contrast to grafting with segments of the patella and/or other tissues.

A 10-patient safety study in 2015 had promising results and the BEAR II study is enrolling patients. The surgery has shown promising results in animals and may help prevent early arthritis by restoring the knee closer to normal than tendon grafting can do. The goal of the current trial is the study the BEAR (TM) procedure in more patients to determine if the new technique is as good as ACL reconstruction for a larger number of patients. Learn more about this study by visiting our BEAR (TM) trial page or Vector - Boston Children's Hospital's science and innovation clinical blog.

Platelet-rich plasma

The Sports Medicine Division uses the latest in tendon regeneration—the application of platelet-rich plasma. This treatment stimulates tissue regeneration in difficult-to-heal areas such as tendons (including the Achilles, elbow and patella) that don’t respond to physical therapy or to limits on activity.

There are normally many healing growth factors in platelets. Platelet-rich plasma can take advantage of this and use these growth factors to stimulate healing. The platelet-rich plasma is typically injected into the affected areas with ultrasound guidance.

The Sports Medicine Division in the Orthopedic Center at Boston Children's conducts research into:

•   mechanisms of sports injuries
•   techniques of rehabilitation and treatment
•   physiology of exercise and conditioning

Ongoing research includes the study of:

•   knee injuries
•   running injuries
•   injuries to pre-adolescent children
•   the psychological impact of sports and sports injuries
•   the treatment and prevention of injuries to dancers

Program director Lyle J. Micheli, MD, is one of the world’s leading authorities on sports care. Micheli has treated world-renowned dancers and professional athletes and is the author of hundreds of published clinical studies, scholarly review articles and books.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

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