The complications of orthopedic surgery on knee ligaments are significant and frequent. The ligament grafts are profoundly weakened about eight weeks after surgery. At this time their strength is about 10 percent of its initial strength! It is only 50 percent of initial strength after one year. In two to three years the grafts are at their strongest, and then, less than their initial strength.(1) Compare this to one study where ligament strength was measured after a six-week period of doing Prolotherapy on knee ligaments. The results showed that in every case Prolotherapy increased ligamentous mass, thickness, and cross-sectional area as well as the ligament strength. Prolotherapy in a six-week period increased ligament mass by 44 percent, ligament thickness by 27 percent, and the ligament-bone junction strength by 28 percent.(2)

There are other techniques for ACL problems, including artificial grafts These artificial grafts (e.g., Gortex) lead to particularly poor results with very high complications!(3)

Arthrofibrosis (a scarred, painful, stiff, knee with limited use) followed arthroscopic ACL reconstruction in 10 percent of the cases, when associated with the repair of a torn meniscus!(4) (See A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears)

In an Australian study, patients were followed up after 7.4 years. Fifty-seven percent had pain on exertion. There was an overall significant deterioration of the anterior-posterior stability of the knee, indicating a failure of the ligament graft integrity with time.(5)
 

In another study of patients followed for two to seven years after surgery, seven percent of the grafts failed and another 26 percent had only "fair" results. (6)

The truly phenomenal news is that Prolotherapy has been shown to stimulate healing in torn cruciate ligaments! The main evidence for this are the many athletes already healed by Prolotherapy. In a small study of athletes who had torn the cruciate ligaments, the knees were examined with a commercially-available computerized instrument, called an electrogoniometer, before and after Prolotherapy to their knees. The results were wonderful! The joint looseness was significantly decreased and the pain was markedly reduced or eliminated. They returned to a higher level of functioning, many returning to sports. (7)
 

Even more impressive were the results of a double-blind placebo-controlled study of dextrose Prolotherapy for knee osteoarthritis with and without ACL laxity, performed by K. Dean Reeves, M.D. The study participants had six months or more of pain, along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage, radiographically, in at least one compartment. The study involved the injection of a dextrose Prolotherapy solution, bimonthly, comparing it to a control solution into 111 knees in 68 patients with osteoarthritis. The results showed that at 12 months, after six Prolotherapy injections, the dextrose-treated knees improved in pain (44% decrease), swelling complaints (63% decrease), knee buckling frequency (85% decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic readings of 0- and 12-month films revealed stability of all radiographic variables with two variables improving with statistical significance (lateral patellofemoral cartilage thickness and distal femur width in millimeter, both of which signify cartilage growth). Knees with ACL laxity showed statistically significant improvements in pain, swelling, joint flexion, and joint laxity. Amazingly, eight out of the 13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion of one year. (8) These results were with only one Prolotherapy injections, (Watch where do Prolotherapy injections go and do they hurt?)  into the knee joints at each session. In other words, the ACL ligament attachments were not treated separately, which is routinely done during Prolotherapy for ACL laxity. Imagine what the results would be like if the ACL itself was treated! Yes, the athlete has a choice-Prolotherapy or surgery.
 

1. Tria, A. Ligaments of the Knee. New York, NY: Churchill Livingstone Inc., 1995, p. 167.
2. Liu, Y. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connective Tissue Research. 1983; 2:95-102.
3. Paulos, L. The Gore-tex anterior cruciate ligament prosthesis. A long-term follow up. American Journal of Sports Medicine. 1992; 20:246-252. Letsch, R. Replacement of the anterior cruciate ligament by a PET prosthesis (Trevira extra-strength as a salvage procedure in chronically unstable previously operated knee joints). Unfallchirurgie. 1994; 20:293-301.
4. Austin, K. Complications of arthroscopic meniscal repair. American Journal of Sports Medicine. 1993; 21:864-868.
5. Cross, M. Acute repair of injury to the anterior cruciate ligament. A long-term follow up. American Journal of Sports Medicine. 1993; 21:128-131.
6. Noyes, F. Reconstruction of the anterior ligament with human allograft. Comparison of early and later results. Journal of Bone and Joint Surgery (American) 1996; 78: 524-537.
7. Ongley, M. Ligament instability of the knees: a new approach to treatment. Manual Medicine. 1988; 3:152-154.
8. Reeves, K. Randomized prospective double-blind placebo-controlled study of dextrose Prolotherapy for knee osteoarthritis with and without ACL laxity. Alternative Therapies 2000; 2:68-80.