ACL injury- Is surgery the only option?

An ACL injury is a tear or sprain in the anterior cruciate ligament (ACL) that is one of the major ligaments present in your knee. ACL is ligament tissues that hold bones together in knee and keep it stable. In general, the incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing, and soccer. With ACL injury, knee may swell, become unstable and too painful to bear.
There are number of risk factors that increase the risk of having ACL injury

• Being female - due to differences in anatomy, muscle strength and hormonal influences
• Playing certain sports, such as soccer, football, basketball, gymnastics and downhill skiing
• Footwear that doesn't fit properly
• The use of poorly maintained sports equipment, such as ski bindings that aren't adjusted properly

 Treatment Options for ACL injury
Depending on the extent of ACL injury, treatment option varies from patient to patient. The nonsurgical treatment may include rest and rehabilitation exercises that help in regaining strength and stability. Proper training programmes are also available that educates the patient how to prevent instability and help reduce the risk of an ACL injury.  The use of a hinged knee brace is also prescribed in some of the cases. Surgical treatment is usually advised in combined injuries (ACL tears in combination with other injuries in the knee).
Stem cell therapy- An emerging treatment modality for ACL tear
With advancements made in stem cell field, there is now another option to be considered that can get you back to you playing ground in less time. Stem cells are naïve cells of body, which have capability of regenerating the damaged tissues. Stem cell therapy procedure is minimally invasive 3-hour process, requiring no general anesthesia and a far less painful recovery.
The stem cells can be harvested from various sources such as fat tissue, bone marrow etc.  With the use of liposuction device, a small amount of fat tissue is typically taken from the lower abdomen Bone marrow can be harvested from the iliac crest that is a rich source of growth factors and stem cells as well. Stem cells are isolated and concentrated in sterile environment for the injections for knees. During the injection, the stem cells are placed into the ligament with image guided techniques. The stem cells and growth factors are then locally delivered into the damaged ligament as well as into other areas of the injured joint space. The results of pre-clinical and clinical trials have provided encouraging evidence of efficacy and safety of stem cell therapies for the treatment of knee injuries.
In some specific cases, surgery may be the treatment of choice, but in others stem cell therapy is emerging as a better option to consider before going for surgery.

Is knee replacement surgery the only option?

Nowadays, more and more patients are going to doctors with common causes of knee injuries, such as fractures, dislocations, sprains, and ligament tears. Knee injury in recent times has become one of the serious issues that doctors are dealing with.

Knee is a complex weight bearing joint with many components, making it vulnerable to variety of injuries. Although many knee injuries can be successfully treated with simple measures, such as bracing and rehabilitation exercises, other injuries may require surgeries to care for. However, if your knee is damaged by some of the painful and progressive degenerative disorders, such as arthritis; you will be either suggested for steroidal medicines or knee replacement surgery by your healthcare professional. As a matter of fact, surgery can bring various other complications like opportunistic infection, delayed healing, long stay in the hospital and cost; thus it’s always better to stay away from surgeries. Additionally long term exposure to steroidal medicine may initiate other long term complications with different organs.

At present in the initial stage of your developing arthritis, many rehabilitation practices may as well be suggested to minimize the progressive damage of the disorder and reduce the pain associated with the same.

Following measures can be noted as precautionary factors to gain symptomatic relief from arthritis:

Weight Loss and Exercise: Losing weight may help you lose the pain to a great extent. Being just 10 pounds overweight, may add up average 60 pounds of force on your knee when you move any further. Exercise thus can definitely help you achieve your weight loss goals, while strengthening your muscles and reducing pain.

Working with a Physiotherapist: It is always advisable to work in co-ordination with a physiotherapist, who knows all the exercises and who can design a schedule that may help you to reduce pain and strengthen the key muscles that affect your knees.

Knee Injections (Hyaluronic Acid): Knee injections of hyaluronic acid lubricate the knee by spreading in between the joints. These injections may help the cartilage and bone tissues slide more smoothly in the joint; thus it acts as a shock absorber, reducing the fiction between two bones and hence minimizing the pain. The technique helps reduce pain and improve knee mobility. Potential side effects may sometimes include additional swelling and pain.

Medication or Cortisone Shots: Medication, including over-the-counter pain relievers and topical creams with the numbing agent’s, such as lidocaine or Marcaine, etc; may help control your knee pain. Your doctor might also recommend an injection of either steroids or cortisone. Steroids The steroids are injected at the site of inflammation. They mimic naturally occurring hormones in your body.

Prolotherapy: It is a new approach that uses a dextrose solution, injected into the ligament or tendon to increase the blood flow and supply of nutrients. The dextrose solution is a sugar mixture. This treatment aims to stimulate the tissue, so it will repair itself.

Arthroscopic Surgery: A surgeon may suggest arthroscopic surgery to remove bone fragments or repair tendons and cartilage inside the knee. An arthroscope is a type of camera that allows a surgeon to view the inside of your joint through a small incision. After making two to four incisions, the surgeon uses the arthroscope to operate on the inside of your knee.

Stem Cells: As such all these conventional treatments can only minimize the pain and/or reduce the symptoms; additionally, anti inflammatory drugs as well as steroidal medications can be dangerous, if continued for a longer period of time, posing other health related issues. In this regard, medical professionals as well as people suffering with these silent diseases were desperately in need of an alternative treatment option that can help them get out of their day to day trauma. In this regard, stem cells therapy is like a miracle for patients that can help alleviate the pain and inflammation in joints. Stem cells are very naive cells of the body, which can be differentiated to any kind of cells of any kind of origin. This remarkable ability of them has been exploited by the healthcare system to promote regeneration of different damaged tissues, which is the basis of many diseases.

Vitamin D or Sunshine Vitamin: How is it important for bones?

It is no more a surprise that a vitamin deficiency can be fulfilled by just standing under natural sunlight? Yes the best way to counter widespread vitamin D deficiency and other health problems could be through moderate exposure to natural sunshine. Regular sun exposure, without sunscreen, causes your skin to produce vitamin D naturally. Although humans make 90% of their vitamin D through sun exposure to the skin, but concerns about skin cancers have led to the wide use of sunscreen. Applying sunscreens block the skin from absorbing ultraviolet rays from the sun.

Nowadays, humans spend less time in the sun than at any point in human history and that leads to more and more people to be vitamin D deficient. Vitamin D deficiency is quite common, and a growing list of diseases and conditions are being linked with it. Researchers have marked that from 25 to 50% of children and adults are deficient in Vitamin D. It has been evident from the studies that vitamin D deficiency is a contributing factor in recurrent major depressive disorders with seasonal patterns. Another study revealed that vitamin deficiency is linked with faster growth of breast cancer cells.

Moreover, the association between vitamin D and strong bones has been widely known for years. Vitamin D deficiency can lead to several diseases like Osteomalacia in adults. Osteomalacia interferes with new bone formation or the production of osteoblasts (bone cells). What happens is, human body is constantly works in a process of removing old bone and replacing it with new bone. This is called “bone turnover” and osteomalacia interferes with this process.  In most cases osteomalacia is curable through increased intake of vitamin D, calcium and other bone building nutrients. It is always best to get these minerals from your diet, but daily supplements of vitamin D and calcium will be required as an osteomalacia treatment.

Other causes due to vitamin deficiency are following:

·         Impaired immune system functioning, which puts you at a higher risk for infection

·         Rickets, a condition that most commonly occurs in children causing bone softening

·         Insulin resistance, which affects your ability to use insulin to process blood sugar

·         Thin or brittle bones, which increases your risk for osteoporosis

Furthermore there are many ways to fulfill vitamin D deficiency but natural sunlight can benefit you in other ways as well. When skin is exposed to sunlight, Nitric oxide is produced which lowers blood pressure. Vitamin D also plays an important role in preventing and treating numerous long-term health issues, including some types of cancer, asthma, diabetes and cognitive impairment in older adults.

Sunlight is the best and only natural source of vitamin D. Unlike dietary or supplementary vitamin D, when you get your ‘D’ from sunshine your body takes what it needs, and de-metabolizes any extra.

Hence, exposing bare skin to ultraviolet B rays in sunlight for about 10 minutes per day is typically enough time to manufacture a sufficient amount of vitamin D.