The Athlete's Guide to Percutaneous ACL Repair (Perc-ACLR)

Published in The Ospina Orthopedic Blog ~ 7 min read ~ Last Updated: January 5, 2026

The ACL Injury: A Career-Ender No More?

To most athletes, the "pop" of an Anterior Cruciate Ligament (ACL) tear is perhaps the most dreaded sound in sports. It is a visceral signal that typically initiates a rigid, pre-determined pathway: surgical reconstruction, the harvesting of tendons from the hamstring or patella, significant muscular atrophy, and a grueling 9-12 month rehabilitation period.

Even with this aggressive intervention, the long-term data on surgical ACL reconstruction reveals unsettling truths. Studies indicate that reconstruction does not necessarily prevent the early onset of osteoarthritis (OA), and re-tear rates—particularly in younger athletes—can range from 6% to as high as 25% depending on the graft type and return-to-sport timing. Many athletes find that while their knee is "stable," it never quite feels the same and lacks the intuitive responsiveness of the original joint.

However, the assumption that a torn ACL must be surgically replaced is being challenged by advances in Regenerative Orthopedics. At Ospina Medical, we offer the Percutaneous ACL Repair (Perc-ACLR) procedure, a regenerative treatment that fundamentally alters the landscape of sports medicine by prioritizing the preservation of native tissue over its removal.

The Biological Hurdle: Why the ACL Doesn't Heal

To understand the breakthrough of Perc-ACLR, one must first understand why the ACL struggles to recover naturally. Unlike the Medial Collateral Ligament (MCL), which is extra-articular (outside the joint) and heals readily, the ACL is intra-articular (inside the knee joint). It is constantly bathed in synovial fluid.

When the ACL tears, the body attempts to form a fibrin clot—the necessary scaffolding for repair. However, enzymes in the synovial fluid, such as plasmin, rapidly dissolve this clot before healing can commence. Without a stable bridge connecting the torn ends, the ligament stumps retract and eventually atrophy. This "hostile" synovial environment is the primary reason ACL injuries have historically been deemed surgical cases.

What is Perc-ACLR?

Perc-ACLR is a sophisticated, image-guided injection procedure designed to overcome this biological barrier. Instead of drilling tunnels into the femur and tibia to anchor a graft, we inject a high concentration of the patient's own Bone Marrow Concentrate (BMC), which contains stem cells, directly into the torn fibers of the ACL.

Bone Marrow Concentrate is harvested from the patient's iliac crest (hip bone). This aspirate is processed in our on-site lab to concentrate the Mesenchymal Stem Cells (MSCs), hematopoietic stem cells, and platelets. The resulting injectate is a potent biologic cocktail capable of modulating inflammation and signaling tissue repair.

Dr. Matthew Kohler utilizes high-precision fluoroscopy (real-time X-ray) to visualize the distinct anteromedial and posterolateral bundles of the ACL. This is not a blind intra-articular injection; it is a pinpoint delivery of healing agents into the tear site. The dense cellular injectate acts as a "super-clot" that is more resistant to synovial breakdown, providing the necessary scaffold and signaling for the ligament fibers to bridge and remodel.

The Evidence: Radiographic and Functional Outcomes

The efficacy of this approach is backed by seminal research. A groundbreaking case series published by Centeno et al. in the Journal of Pain Research (2015) and subsequent registry data published in the Journal of Translational Medicine (2018) have provided objective evidence of repair.

The 2018 study analyzed 29 patients with Grade 1, Grade 2, and Grade 3 (complete) non-retracted tears. The findings were significant: 

• MRI Evidence of Improvement: Post-procedure MRIs demonstrated objective improvements in ligament structural integrity. Quantitative analysis showed that the ACLs became darker (hypointense) and more organized on imaging, indicating a return to normal ligament density and orientation. Specifically, 7 of 10 patients in the initial cohort showed improvement in at least four of five objective MRI measures of ACL integrity. 
• Functional Restoration: Patients reported high satisfaction rates and substantial improvements in functional scores. The mean Lower Extremity Functional Scale (LEFS) scores increased significantly, and the vast majority of patients returned to their sporting activities without surgery. 
• Durability: Follow-up data suggests that these repairs are durable, with low re-injury rates comparable to or better than surgical reconstruction in select populations.

It is crucial to define candidacy accurately. This procedure is most effective for partial tears and complete tears where the ligament sheath is still intact (non-retracted). Tears where the ligament ends have snapped back significantly (retracted) typically still require surgical intervention.

Why Choose Non-Surgical Repair?

Wanting to avoid surgery is a natural experience, but there are a few reasons why it might also be a strategic choice: 

1. Preservation of Proprioception: The native ACL is rich in mechanoreceptors that tell your brain where your knee is in space. Surgical grafts lack this neural connection. Preserving the native ligament maintains this vital proprioception, potentially reducing the risk of future injury. 
2. Biomechanics: Surgical reconstruction alters the pivot point and rotation of the knee. Perc-ACLR maintains the original anatomy and biomechanics of the joint. 
3. Reduced Trauma: The recovery from an injection is fundamentally less traumatic than recovering from the drilling of bone tunnels and the harvesting of hamstring or patellar tendons, which can lead to permanent donor site morbidity. 
4. Accelerated Rehabilitation: While biology takes time to mature, the lack of surgical trauma often allows for a more progressive physical therapy timeline. At Ospina Medical, we work closely with your physical therapist to guide a return-to-play protocol that respects the biological healing of the tissue while maintaining muscular strength.

Conclusion

For patients facing an ACL diagnosis, the rush to surgery is no longer the only path. There is a critical window of opportunity to save the native ligament. Procedures using Regenexx injectates represent the latest in orthopedic care, offering a scientifically validated option to support the body's natural healing process.

Contact Ospina Medical today to schedule a comprehensive evaluation with Dr. Matthew Kohler, including a detailed MRI review, to determine if you are a candidate for Perc-ACLR.

A Riley Publication ~ Branded Thought Leadership by Riley Partners and Publications, Inc.

Medically Reviewed by: Matthew Kohler, MD

Disclaimer

This article is for informational purposes only and does not constitute medical advice. Please consult with your healthcare provider for any personal health concerns.

References

Centeno, C. J., et al. (2015). Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. Journal of Pain Research, 8, 437-447.

Centeno, C., et al. (2018). Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. Journal of Translational Medicine, 16(1), 246.

Centeno, C., et al. (2022). Non-surgical treatment of anterior cruciate ligament tears with percutaneous bone marrow concentrate and platelet products versus exercise therapy: a randomized-controlled, crossover trial with 2-year follow-up. Biologic Orthopedics Journal, 3(SP2), e7-e20.

Paschos, N. K., & Howell, S. M. (2016). Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Reviews, 1(11), 398-408.

Seijas, R., et al. (2020). Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors. World Journal of Orthopedics, 5(3), 373-378.

Theodore, E., et al. (2021). Magnetic resonance imaging evidence of healing of partial anterior cruciate ligament tears following platelet-rich plasma injection. Regenerative Medicine, 16(5), 453-462.