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

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 re-rupture 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.

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

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.

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 ruptures 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.”