ACL repair: What it’s like to be first to have a new surgery

Dr. Martha Murray explains bridge-enhanced ACL repair
Dr. Martha Murray explains bridge-enhanced ACL repair

At the beginning of the historically snowy Boston 2015 winter, I took a ski trip to the Green Mountains with some friends. On the morning of our first day, I lost control and, while tumbling to a halt, I heard two pops: One was my right ski-binding opening and the other was my left anterior cruciate ligament (ACL) rupturing.

As a doctoral student at the Harvard T.H. Chan School of Public Health, I found myself exploring treatment options, even before I got the MRI scan to confirm the ACL tear.

I was particularly troubled to hear about the high risk of early-onset osteoarthritis in the injured knee with the current standard surgery.

After following the research, I was encouraged to learn Dr. Martha Murray and her team at Boston Children’s Hospital Sports Medicine had just started recruiting for a first-in-humans safety trial testing a promising new ACL-repair method.

I called Dr. Murray’s research coordinator and sent my MRI results to find out if I was eligible to participate in the trial. Within a few hours, they returned my call. I was eager to learn more.

From ACL reconstruction to ACL repair

What I thought would be a brief Saturday morning meeting with Dr. Murray’s team turned into a four-hour marathon. I was fascinated by the research. I peppered them with questions and also reviewed some of Dr. Murray’s original research on repairing ACLs.

The new method — bridge-enhanced ACL repair (BEAR) — relies on the body’s ability to heal itself. Unlike other ligaments, when the ACL tears, its ends don’t reconnect because the synovial fluid that surrounds the ACL inhibits healing. So the conventional way to manage an ACL tear is to remove the torn ends of the ACL and construct a new ACL from a tendon graft. This is why ACL surgery is referred to as ACL reconstruction.

Dr. Murray’s idea — ACL repair — seemed like a better option for treating an ACL tear.

She developed a bridging scaffold to insert into the knee. It creates an environment that allows the torn ends of the ACL to grow and reconnect.

I realized that instead of letting my injury be a personal setback, this clinical trial could give me the opportunity to become part of a story that is larger than I am. By participating in the BEAR trial, I could contribute to science, while also having an outcome that I expected to be similar to or better than I would with ACL reconstruction.

I decided to enroll in the trial.

My road from ACL surgery to ACL injury recovery

Dr. Murray and her team aimed to perform the surgery within 30 days of injury, but for me the day couldn’t come soon enough.

Dr. Lyle Micheli, Dr. Murray’s mentor and the director of the Boston Children’s Sports Medicine Division, performed my surgery — the first BEAR procedure — on Feb. 23, 2015, three weeks after my injury.

The first two weeks after surgery were the hardest. All ACL patients have to wear a restrictive hip-to-ankle, post-operative brace for about six weeks. On the positive side, I was encouraged to see progress every day. I celebrated small victories, like bending my knee enough to sit on a chair and walking without crutches along the Charles River.

After checking my progress daily during the first two weeks after surgery, I continued to reach new milestones but on a weekly schedule.

A key milestone occurred six weeks after the surgery when I transitioned into a sports brace. It’s a pretty impressive piece of engineering: a carbon-fiber brace that was custom made based on a 3-D printed model of my leg.

Three months after my surgery, I had my first post-operative MRI, which could suggest whether or not my ACL was healing.

Corey looks on as Dr. Micheli reviews his MRI results
Corey looks on as Dr. Micheli reviews his MRI results

Dr. Murray and her team huddled over the MRI images as they emerged one-by-one, while I was still in the MRI tube. When I emerged, we were relieved and elated to see signs the ACL was indeed healing.

It’s been more than a year since I tore my ACL. I am far along on the road to recovery; I’m especially appreciative of refreshed feelings of optimism and freedom and enjoying my return to a mobile, active lifestyle.

I’m optimistic that I will make a full recovery on a similar schedule while recovering from ACL reconstruction. I’m hopeful that one difference between BEAR and ACL reconstruction will be a reduced chance of arthritis later in life, so when I’m 50 I’ll be hiking, running and competing in triathlons.

Corey_after ACL repair

Beyond that, my hope is for this surgery to become a routine and better choice for patients in the coming years. I hope to be not only the first of 10 patients to have their ACL repaired by the BEAR procedure, but also the first of thousands.

Learn more about the Boston Children’s BEAR trial.

About the blogger: Corey Peak is a doctoral student at the Harvard T.H. Chan School of Public Health and was the first patient to undergo Bridge-Enhanced ACL Repair. He’s enjoying his active lifestyle, including running. biking and hiking.