Prolotherapy to the Anterior Cruciate Ligament

Rodney Van Pelt, MDRodney Van Pelt, MD

Prolotherapy Technique on Injecting the Anterior Cruciate Ligament. Journal of Prolotherapy. 2009;1:36-38.

Anterior Cruciate Ligament (ACL) injuries are very common in any sports medicine practice. Incomplete tears and sprains are the most common injury to the ACL. In the author’s experience, if an ACL sprain or incomplete tear does not heal on its own, it will most likely remain chronic, unless Prolotherapy is done. The technique of Prolotherapy for stimulating ACL healing is shown.

Here he is. O.T. has just walked into your office. He is a 69 year-old paving company owner, complaining that his right knee hurts and has been gradually getting worse over the last two years. He complains of pain with descending a slope and prolonged walking. He has a history of twisting of his knee with an unexpected step into a hole at the work site. On exam he has a mild effusion of the right knee and positive anterior drawer test. The rest of the exam is negative. He has a partially torn Anterior Cruciate Ligament (ACL).

This orthopedic condition brings the skilled Prolotherapy doctor special challenges. The cruciate ligaments are almost two inches long. They are located in the center of the knee, rather than on the outside. Also they are intra-capsular but extra-synovial.

We all know that we see more ACL than Posterior Cruciate Ligament (PCL) injuries. This is for two main reasons. First, the ACL stabilizes the knee in multiple places. This means it is vulnerable to injury from traumatic forces from several directions. Secondly, the blood supply to the PCL is more generous than the supply to the ACL. This leaves the ACL more vulnerable to injury and less able to heal after injury.

Since the cruciate ligaments are not in the synovial fluid, simple Prolotherapy intra-articular injections will not lead to strengthening of the cruciates. We must therefore identify the anterior and posterior insertion sites, and carefully inject the proliferant there.

Let’s review the ACL anatomy. The proximal end (posterior portion) of the ligament is located posteriorly on the medial superior aspect of the lateral condyle of the femur. From there the ligament runs distally, slightly medially and anterior to its attachment (anterior portion) on the tibia. It attaches on the tibial plateau between the tibial eminences just anterior to the coronal midline and slightly medial to the sagittal midline. The origin is about 20mm by 10mm. The insertion is about 10mm by 30mm, with the long axis running anterior/posterior.

Read the full article at the Journal of Prolotherapy.

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