Sports

Sprinting 4 weeks after an ACL repair? New technique could dramatically reduce rehab, recovery


It took a lot to get Kadin Jarrouj off the football field during his senior season at Winfield (W.V.) High. He blocked on the offensive line. He terrorized opponents as a defensive lineman. When it was time for the offense to surrender the ball, he stepped back and punted to the opposition. When the Generals needed an extra point or field goal, he was the one kicking the ball through the uprights.

What ultimately finished his high school career was basic reality. As supernatural as it might seem for one young man to handle so much, Kadin turned out to be human.

“Things were going well, looking at playoffs, and the eighth game, probably halfway through the first quarter, I bit on a jet sweep and took a plant step right as a pulling guard kind of came at my side,” he told Sporting News. “My body went over top of the side of my knee. I felt six or seven different pops. I knew something was wrong.”

Jarrouj limped off the field, thought he might even return to the game, but when test results came back several days later, he heard the three letters every athlete dreads: A-C-L. It’s become so much a part of the athletic lexicon, it may be forgotten these three letters stand for “anterior cruciate ligament.” With just weeks remaining in his senior season, with a West Virginia state championship not far from his reach, Jarrouj’s season ended with a torn ACL.

You’ve heard this story before, though, right?

Kadin Jarrouj

It’s been decades since ACL reconstruction became a common surgical procedure, and we’ve seen the careers of thousands of athletes rescued. It’s come at the price of a fair amount of discomfort, hours of rehab and often a year away from competition, but that’s the perpetual bad-luck bargain for this particular injury.

Or, that deal could be about to change.

“I had surgery in November, and I started practicing in late February to early March on a full release for track. So it was between three and four months before I was back,” Jarrouj told SN. “And I did shot and discus, so it’s a lot of twisting and cutting, a lot of pressure on those knees. And it felt… great. I was amazed. We went through a month of training with no issues at all.”

MORE: Week 12 college football predictions

The story of his remarkable recovery would have been a lot more romantic had Jarrouj gone on to win a state title in the shot or disc within six months of tearing his ACL, but the COVID-19 pandemic spoiled that ending by wiping out West Virginia’s 2020 high school spring sports season. Instead, he moved on to the University of Charleston, where he is a freshman playing on the defensive line. This really isn’t about drama, though. It’s about the science of the ACL technique being pioneered by orthopedic surgeon Dr. Chad Lavender of Charleston, an approach that could dramatically reduce recovery times for athletes who experience this feared injury.

We’re talking about ACL recovery possibly being measured more often in weeks than months or years. Jarrouj is among many athletes who’ve been recent patients of Lavender who report being able to resume training activities – from jogging to sprinting to jumping – inside two months and competing soon after.

He calls his approach the “Lavender Fertilized ACL.”

It essentially consists of two tweaks to the traditional approach to ACL reconstruction. The first is harvesting stem cells from the marrow in a patient’s shin bone and the bone residue withdrawn from the small socket drilled to accept the graft and combining them to create a composite – what he describes as a putty-like substance – that is injected into the socket where a quad tendon graft is placed. He believes that promotes a smoother process for long-term healing of the graft.

Lavender also employs an internal brace positioned near the center of the graft he believes has helped his patients accelerate their rehabilitation processes.

Lavender was around injured athletes as an undergraduate student at West Virginia, when he walked on to the Mountaineers football squad as a long-snapper. “I had friends of mine that didn’t go to the league because they tore their ACL,” he said. His medical training led him back to the playing field, in a sense, as a surgeon with a specialty in sports medicine practicing at Marshall Health and serving Marshall athletics as a team physician.

“I saw that it was taking athletes so long to get back,” Lavender told Sporting News. “I saw there was a cyst that developed in the tibia around the grafts, to be technical about it. And basically, to be non-technical, they just weren’t healing to the bone, the ACL grafts we were putting in. So we literally got out out a piece of paper and looked at different options, and there were all kinds of new technologies coming out that allowed us to take stem cells from a patient during a procedure and create our composite graft with their own bone graft, too.

“That’s how we came up with the technique, literally from scratch, in addition to adding on to other techniques that were out there already.”

—–

There was a single, obvious question to ask Lavender even before he’d attempted to explain his technique and procedure to someone who got a C in high school chemistry: Why isn’t everybody doing this?

“It’s early. We just had our first two-year follow-up published. We just finished enrollment in our Level 1 clinical trial,” Lavender said. “I would say there have been over 500 of these that have been done across America.

“You have to understand – people have asked, ‘Has an NFL player had it done?’ Those agents and those team docs are not early adopters to new technologies. If they push the envelope like I have, and they let a kid at 12 weeks test and try to push a kid back and they have a failure, it’s not a good situation. So that’s the answer to that question: It’s early in the process. While we’ve been doing this for three to four years, that’s really new in the grand scheme of techniques in medicine. Any time you study something, it takes time.

“There’s a lot of different steps to the procedure. Surgeons don’t always embrace change easily. They’re kind of creatures of habit. And that’s part of the problem: For 30 years, we’ve done a patella tendon graft and really haven’t improved our results at all. The fact it takes most athletes a good nine months – and in some cases a year-and-a-half to two years – to recover, depending on sport and performance, that’s a long time.”

There was a time, long before Lavender became a surgeon, when a torn anterior cruciate ligament essentially was a career-ending injury. By the 1980s, it became fairly common for athletes who needed ACL reconstructions to require a year away from their sports to recover fully.

Rod Woodson of the Pittsburgh Steelers famously accelerated his rehabilitation in 1995; he tore his ACL when attempting to tackle the Lions’ Barry Sanders in the opening game, then asked the team not to put him on injured reserve in case he could recover to play in the Super Bowl. The Steelers didn’t, and he did. Woodson played against the Cowboys in Super Bowl 30 and recorded one pass breakup.

For most athletes since, though, ACL recovery has taken between 6-12 months. A 2016 study of 80 amateur athletes showed 80 percent returned to sports after an eight-month period.

Donavin Davis injured his knee in the final game of his football career at West Virginia’s South Charleston High. After Lavender performed the “fertilized ACL” procedure, Davis was running at four weeks and completed a 40-yard dash in 4.8 seconds at five weeks post-surgery; before the injury he consistently ran in the range of 4.5 to 4.6 seconds. He is a freshman walk-on for the West Virginia Mountaineers.

“I was running fullspeed. I felt comfortable. I felt great. I still feel great,” Davis told SN. “I was definitely surprised that was even an option. For him to tell me I could play in just a little amount of time, it gave me hope. I’m not going to lie: There was obviously doubt in my mind, because I’d never heard of that before.”

—-

In his teens, motocross racer Blake Bollinger twice went through ACL reconstructions on his left knee. When he tore that ligament again because of a crash at the beginning of 2020, he went to a few doctors near his hometown in North Carolina, and a few more in Charlotte, and several told him they couldn’t do anything to substantively repair the damage.

“By a miracle, somebody messaged me on Instagram and recommended Dr. Lavender. I was pretty desperate at that point,” Bollinger told SN. “Right away, he gave me the confidence, said he could fix it and not to worry about it.”

Husqvarna Motorcycles

The surgery took place in February 2020, and he was riding again by September, despite the increased complication of the two previous tears. When he tore his right ACL in November, he already knew which doctor to see. Because that knee had less damage, he was back racing at the highest level in less than four months. Bollinger ranks 13th on the Grand National Cross Country (GNCC) circuit in 2021.

“The first surgery, we wanted to give it time, because he pretty much said: This is your last chance if you mess it up again,” Bollinger said. “The other knee, I rushed it because it’s a good knee, and if I mess it up, I’ll just have to do it again. And I already missed a whole year of racing. So you don’t want to sit around too long; you get forgotten about.”

Lavender’s data has shown “rush” might not be the accurate verb to use in such cases. That shorter recovery time appears to be the norm among patients who’ve received the “fertilized ACL” graft.

“We haven’t found any increased risk or any increased complications, and I’ve done over 120 of these,” Lavender said. “Many of the patients in our clinical trial are over a year out; we haven’t seen any early or long-term complications that were significant, and we also have had no infections. Those were things I worried about initially.”

There’s also some evidence to indicate this technique could be more durable. “The data shows that up to 25 percent – one in four people – that tear an ACL will tear either the graft or the opposite knee,” Lavender said in an August interview. “The question is why? And we don’t really know the answer to why.

“What I will tell you about our technique: We haven’t had one re-rupture that we know about. So in 100 or more patients in the last four years, we haven’t had one re-injury. Not to say that can’t happen. “We’re looking at that in this trial, but in the next trial what we’re looking at is, let’s say we return a kid at four months. If the reinjury rate – or rerupture rate, is what we call it – is not much higher than with a wait of nine months, then we have to start looking and saying: Hey, this works, let’s return them earlier, this technique does a good job of holding up.”

Lavender has spoken at numerous surgeon conferences, including one in Baltimore this month, and next month he’ll speak in Naples, Fla., Grand Rapids, Mich., and Chicago. He has shared information about the technique on global and regional webinars. He is seeing a high level of interest and even excitement because of the results.

“That’s the question I get asked most: How did it feel with the first 10 you did? Because other people can come in now and do it, and they can lean back on the data that we’ve developed. To be a pioneer in something is not easy,” Lavender said. “I even went so far as to put my name on the technique; I don’t know if that was the smartest thing to do, but I believed in it.”

In those early operations, there were struggles to get the concentration of the stem-cell/bone “putty” just right, as well as placing it in the graft socket. Eventually, Lavender and his team felt comfortable with a procedure that can be reproduced on a series of patients. He said “other folks that are out there doing it” are also seeing good results.

Lavender had a paper published in September in a journal called “Arthroscopy Sports Medicine and Rehabilitation” on the nature and efficacy of the technique that involves a two-year follow-up account of the first 16 surgeries performed. Explanations of the technique itself were published three times previously in the “Arthroscopy Techniques” journal.

He expects data to be released within the next four months from the clinical trial. The next step, he said, is a “multi-center trial” that will demonstrate whether the level of effectiveness can be replicated by surgeons elsewhere.

“We’ve had professional athletes come in for it, and we’ve also been really close on a couple name-brand players,” Lavender said. “But like I was telling you earlier, it’s just early.”

MORE: NFL Week 11 picks against the spread

————-

When I mentioned all this to an orthopedic surgeon who is a team physician for a top-25 college football team, the response was skeptical. He explained that “orthobiologics” – another name for the stem cell “putty” used in the fertilized ACL procedure – have been in use for more than a decade to promote healing. Attempts decades ago to employ a “ligament augmentation device” that might be considered similar to the internal brace were not successful, the doctor said, “because the graft needs to see stress in order to heal.”

He acknowledged there are “genetic freaks” who have been able to accelerate the healing process, but also told a story of being on the field before one game when the team doc for the opponent pointed out a starting cornerback who was only three months out from his ACL repair and getting ready to start.

“Second play, the kid reruptures his graft,” the surgeon said. “What we’re trying to do is change biology. Biology always wins.”

Lavender said the difference with his approach to “orthobiologics” is the combination of the patient’s own stem cells and bone and its use in the tunnels into which the ACL grafts are placed, and also how that material is placed.

Other surgeons are intrigued. Dr. Sam Akhavan works with baseball’s Pittsburgh Pirates and Pittsburgh Riverhounds of the United Soccer League’s Championship division and is part of the Allegheny Health Network. He has become familiar with Lavender’s work through his lectures.

“I’ve seen all his data, so I’m pretty familiar with the way he does the procedure and everything else. To me, I think he’s pushing the envelope, which is something surgeons kind of need to do, but he’s doing it the right way,” Akhavan told SN. “He’s not just blindly doing this. He’s doing things that make logical sense and he’s doing it in step-wise fashion; he’s not just saying, ‘This is what I’m doing,’ he’s actually studying it while he’s doing it.

“The patients that he’s doing, he’s keeping tabs on them, he’s doing MRIs on them, he’s doing all this stuff. And what that’s doing is allowing the rest of us to kind of see: Is this something that’s worth it? Is it working? Is it not working?

“His studies – you look at some of those CTs and MRIs that he’s done, I can tell you, my ACLs don’t look like that at four months, the few times I’ve had to get an MRI on them. They’re not so well grown in. There’s definitely something there in the way he’s doing it.”

Akhavan said this surgery, in his opinion, would not be right for everyone. It does come at an increased cost, which is a factor. Lavender told SN it can be $1-2,000 more expensive than a traditional ACL reconstruction, although he believes that can be mitigated by the results, “especially for a high-end athlete.”

In addition to the high-level collegiate or professional athlete eager to return to competition, though, Akhavan also sees utility in this technique for high school-aged athletes who play multiple sports or those whose activities can run through much of the year – say, a high school basketball player injured in season who would want to return for spring and summer showcase tournaments and camps.

“I think he’s really close. It’s starting to catch,” Akhavan said. “From the standpoint of ACLs, you’re taking a procedure that we have about a 95-percent success rate. That’s fantastic, right? One of my friends said, ‘You’re negotiating for pennies at a car dealership.’

“The pendulum is always swinging when it comes to ACL rehab. But the thing Chad’s doing, he’s got videos of these high-level athletes coming back at four months … My patients are barely running at four months. Six months is kind of where we’re at. For the average person, does that really matter? Probably not.

“But let’s say you have a high school kid who’s a two-sport athlete, and he tore his ACL the first week of football camp or whatever, but he also plays baseball in the spring. Guess what? Maybe he gets back by that time and gets to play his second sport. To me, it makes a whole bunch of sense if you can safely push that envelope.”

 




Source link

Leave a Reply

Your email address will not be published. Required fields are marked *