DENVER MAN BORN WITHOUT ACL INSPIRED BOLD REVOLUTION IN KNEE REPAIR

As a toddler, Philip “Puck” Wheaton’s gait was unsteady, even for an 18-month-old, leading his doctor to discover he was born without his ACL, the ligament that holds the knee together.

Wheaton, now a 36-year-old Denver financier and avid skier, nevertheless has enjoyed a lifetime of sports, including soccer, basketball, lacrosse and collegiate rowing.

An innovative Boston surgeon rigged a replacement 34 years ago that made the difference for Wheaton and became a procedure used worldwide.

“If it weren’t for this, I’d been very limited in my activities,” Wheaton said. “And if I’d lived 10,000 years ago, I would have been eaten by a lion.”

Wheaton was missing the anterior cruciate ligament in his right knee. And he was too young for the standard method of reconstructing ACLs, pioneered roughly 10 years earlier. It involved drilling holes through the knee and, in one so young, likely would damage the growth plate.

Wheaton’s surgeon at Boston Children’s Hospital, Dr. Lyle Micheli, improvised. He took the ligament running from hip to shin on the outside of 22-month-old Wheaton’s leg — the iliotibial band or IT band — and threaded it in and wrapped it around his knee to rig an ACL.

AGENESIA LCAHe had no idea if it would work — or if it would grow with Wheaton or impair that ligament’s normal function.

“We didn’t have much of a choice,” Micheli said. “We were holding our breath for four or five years, then we knew we were out of the woods.”

There were a couple of years of braces — and a tiny, never-used walker. Mostly, Micheli said, Wheaton just tore up the playing fields.

“He was a tough little nut,” Micheli said.

The procedure worked so well they started using it to repair traumatic ACL injuries in very young children, pre-puberty.

“It’s one of those procedures that is now used all over the world,” Micheli said. “It’s stood the test of time.”

Micheli estimates he’s performed it 400 to 500 times.

Wheaton says his knees have been great — the right knee as strong as the left. They get plenty of use. He skis 50 days a year. That’s why he moved to Colorado 15 years ago.

The only side effect in the 6-footer has been a little asymmetry, he said. He has a leg length differential of seven-eighths of an inch.

“I’m very grateful to Dr. Micheli and modern medicine,” Wheaton said.

About 400,000 ACL reconstructions — in which the damaged ACL is replaced with a tendon graft — are performed each year in the U.S. because ACL injuries don’t heal well on their own and suture repairs have a failure rate greater than 90 percent, according to Boston Children’s Hospital.

Micheli said the next big innovation in ACL repair in young patients likely will involve biological components.

Micheli’s colleague, Dr. Martha Murray, with the hospital’s Sports Medicine Research Laboratory is experimenting with a less invasive, “bio-enhanced” approach.

“We have just begun a clinical trial for biological repairs,” Micheli said. “It’s the next exciting thing on the horizon.”

Murray and team developed a “protein-based scaffold” to be placed between two torn ends of ACL tissue. They use a few cc’s of the patient’s blood, injected into the scaffold, to stimulate healing.

“It’s like a plug, a sponge,” Micheli said of the scaffold.

It forms a bridge of clotted blood, allowing the two ends of the torn ACL to heal together.

So far it works in animals — and works better in younger animals, Micheli said. It’s expected to work better in younger human patients — high school and college-age athletes.

“If it works in humans,” Micheli said, “it will be revolutionary.”

[ The Denver Post ]

 

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