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ACL Tear – Overview

As you walk, jog, or climb stairs, your knee bears and redistributes forces as high as 2.8 to 3.6 times your body weight, absorbs shocks and balances your body as it moves through space. To be able to achieve all this, the knee relies on a complex structure of bones and muscles.

These structures are held in place by strong bands of tissues, known as ligaments and tendons. While the tendons connect the knee bones to muscles, the ligaments connect one bone to the other.

The bones in the knee – which include the femur, fibula, tibia, and patella – are kept in place during movement by four main ligaments:

  • Anterior cruciate ligament (ACL)
  • Medial collateral ligament (MCL)
  • Lateral collateral ligament (LCL)
  • Posterior cruciate ligament (PCL)

One of these ligaments – the ACL – connects the thigh bone (femur) to the shinbone (tibia). Its role is to prevent the two bones from falling out of alignment during movement, thus avoiding dislocations or other injuries. The ACL also helps keep the knee joint flexible and stable, preventing damage deriving from shock or friction.

The ACL can become torn due to non-traumatic causes, such as the ligament degeneration that occurs as we age. However, in most cases, this injury happens due to non-contact trauma – when the ligament is stretched beyond capacity or in an unnatural direction.

Some of the main causes of a torn ACL include:

  • Excessive stress to the knee (e.g. participating in high-impact sports)
  • Repeated stress, even if less severe, that has a cumulative effect on the ligament and causes micro damage
  • Direct trauma, such as a direct blow to the knee, a fracture, or a dislocation
  • Pivoting or awkwardly landing on the knee. High-risk movements include inward-bending, backward-bending, trusting, or pivoting actions.

Risk factors for ACL tears include being female, having a history of ACL tears, and aging (due to the fact that, as we age, ligaments become weaker, less elastic, and more prone to injury). Taking part in certain sports can also increase the risk of ACL injuries. Studies have found that peak incidence occurs in athletes participating in activities like soccer, basketball, skiing, lacrosse, and football.

Symptoms Of An ACL Tear

An ACL injury will be categorized into one of three grades, depending on how severely torn the ACL is:

  • Grade 1 – The ligament is mildly damaged or stretched.
  • Grade 2 – The ligament has become loose after being stretched beyond capacity.
  • Grade 3 – The ACL has become completely detached from the bone. This type of injury is known as a “rupture” and often requires surgery.

The severity of symptoms will depend on how badly torn the ACL is. However, generally, this type of injury causes the following symptoms:

  • Chronic pain, usually located on the outside aspect of the knee, or at the back of the knee
  • Pain that radiates through the knee and leg
  • Ongoing inflammation, which causes swelling, stiffness, redness, and a sensation that your knee is warm
  • A feeling that your knee is unstable, or unable to bear your body weight
  • Limited range of motion (due to both swelling and reduced motion capabilities of the injured knee)
  • Discomfort while walking or running
  • “Popping” sounds at the time of injury, often followed by sharp pain inside the knee

If your ACL has been completely torn from the bone, you may not be able to walk at all. Even if you can still walk, adding stress to your knee can exacerbate the injury.

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Conventional Treatment Options

The ACL is one of the most frequently injured ligaments in the knee, which makes ACL tears a widespread condition. In some cases, minor tears can heal on their own with at-home care and physical therapy. However, if the tear is severe or due to age-related degeneration of the ligament, it is vital to seek an adequate line of treatment.

Commonly, patients are prescribed medications or corticosteroid injections, or, if the tear is severe, surgery. These options, as we are about to see below, may help alleviate symptoms during pain flare-ups, but they can expose you to significant side effects, risks, and long rehabilitation times.

Corticosteroid Injections

Corticosteroids are the synthetic counterpart of cortisol, a hormone your body produces naturally. This hormone’s main functions include reducing the transmission of pain signals from the injury site to the brain and minimizing inflammation.

Typically, corticosteroids are administered into the knee through injections, where they release pain-relieving substances over time, thus providing a more prolonged effect compared to other drugs.

However, using corticosteroids does have some risks. These include mood changes, muscle weakness, and heightened blood pressure. Even more concerning is the fact that new research has suggested a link between corticosteroid injections and faster progression of knee arthritis, cartilage damage, and adrenal gland insufficiency.


NSAIDs, or nonsteroidal anti-inflammatory drugs, relieve pain by blocking the cyclooxygenase (COX) enzyme, which plays an essential role in the production of prostaglandins. Prostaglandins are chemicals that amplify pain signals while promoting inflammation and triggering swelling in tissues. By blocking the production of prostaglandins at the source, NSAIDs may offer temporary relief from pain.

The fact that NSAIDs are so available and affordable is a double-edged sword: it is easy to start relying on them for quick pain relief. However, taking NSAIDs chronically has its disadvantages. Firstly, these drugs don’t modify, cure, or slow down the progression of disease. Additionally, taking medications regularly can expose you to side effects such as susceptibility to heart attack, stroke, stomach ulcers, kidney dysfunction, and addiction.

ACL Reconstruction Surgery

ACL reconstruction surgery is an invasive procedure that aims at repairing the torn ACL to help the knee regain its function. It involves replacing damaged parts of the ligament with tissue from healthy tendons in the body or with synthetic material.

There are several forms of ACL reconstruction surgery. These include:

  • Autograft: In this form of reconstruction surgery, the doctor collects healthy tissue from another tendon in the body. Depending on which area of the body is used, this surgery can be one of the following ones:
    • Patellar (kneecap) tendon autograft
    • Hamstring tendon autograft
    • Quadriceps tendon autograft
  • Allograft: In this surgery, healthy tissue is collected from a deceased donor.
  • Synthetic graft: In this surgery, synthetic materials (usually carbon fiber and Teflon) are used to replace the ligament.

The cases of ACL tears are on the rise – and, with them, also are the number of ACL reconstruction surgeries performed annually. However, while surgical techniques have been refined over the past years, up to a quarter of patients undergoing ligament reconstruction surgery do not achieve satisfactory outcomes. To make things worse, these invasive interventions come with recovery periods as long as six months.

ACL Restoration

ACL restoration is an innovative surgical intervention performed to stimulate the regeneration of the damaged ligament. In this surgery, an implant is placed in the knee to connect the two ends of the torn ACL. Samples of your blood are then placed within the implant, which will stimulate blood clotting and healing of the injury.

Over time, this surgery allows your body to regrow native tissue. However, this is still an invasive surgical intervention, which has a 14% rate of re-rupture of the ligament.

What Is Platelet-Rich Plasma, Or PRP?

PRP – which stands for platelet rich plasma – refers to a form of regenerative medicine that uses samples of the patient’s own blood. Blood samples are collected and processed to optimize the concentrations of platelets and the growth factors within them. 

  • Platelets are components of the blood, which are responsible for healing processes such as blood clotting. They help heal wounds and regenerate damaged tissue. 
  • Growth factors are proteins contained in platelets, where they are found in “packets” known as alpha granules. The therapeutic potential of growth factors derives from the fact that these proteins are capable of:
    • Stimulating the activity of repair cells within and around the site of injury. These repair cells include stem cells.
    • Calling to action healing and repair cells from other healthy areas of the body to the area in need.

Platelet rich plasma offers high concentrations of platelets, and in turn, of growth factors, which can be delivered to the area in need in a safe, efficient, and non-invasive way. You can think of these injections as “espresso shots,” which have the power to amplify the body’s ability to heal itself.


PRP For ACL Tear

Given the fact that PRP works by supporting the body’s own regenerative abilities, this therapy is considered a form of regenerative medicine. In regenerative orthopedics, PRP can be efficiently used in the treatment of a wide range of musculoskeletal issues, including ligament and tendon tears, arthritis, and joint instability.

To this day, there have been more than 30 randomized trials showcasing the efficiency of PRP in supporting the body’s self-healing abilities by stimulating the activity of stem cells.

In the treatment of ACL tears, PRP has been seen to offer significant advantages. Here’s what science says:

  • In the treatment of mild ACL tears, PRP has been seen to be a “safe, easy to manage treatment, efficient for pain relief and in resuming of sports activities.” (2022)
  • Augmenting treatments with biological approaches such as PRP offer improved healing, faster return to sports and daily activities, and better proprioception (the sense that helps us perceive our body in space) compared to standard approaches. (2017)
  • For patients with knee ligament injuries (such as ACL tears), PRP has been seen to be beneficial in regenerating tissue during the healing process of torn ligaments. (2017)

New studies, such as that completed in 2022, are also looking at the beneficial effects that PRP may have in the recovery process after ACL reconstruction surgery – which is a possibility patients with a ruptured tendon may have to face. These studies suggest that PRP may support the maturation of the graft (the tissue implanted during surgery), relieve pain, and boost knee health.


Why Are Orthagenex PRP Injections Superior?

While PRP injections provide an advanced, non-invasive, and highly effective alternative to treat ACL tears, it’s crucial to remember that not all platelet-rich plasma preparations are the same. Here at Orthagenex, we’re centered on maximizing treatment results and ensuring patient satisfaction above all else.

With this in mind, we’ve pioneered a proprietary protocol which allows us to offer far superior, purer, more concentrated, and entirely customized PRP injections to each patient.

Discover how below.

Image-Guidance To Place PRP Solutions

The first quality that makes Orthagenex’s PRP solutions unique is the use of imaging guidance.

Imaging guidance refers to techniques used to monitor the position of the needle as it enters the skin and delivers PRP to the area in need. This significantly reduces reliance on tactile sensations and enables better needle placement accuracy and, in turn, clinical outcomes.

Currently, the majority of orthopedic practices that offer PRP in the US do not use any form of imaging guidance, which increases the risk of even trained physicians missing the target location. Even in scenarios when imaging guidance is used, many physicians are not trained to accurately interpret results.

At Orthagenex, we believe that nothing should be left to chance when it comes down to helping our patients regain their knee health. That is why we leverage, in combination, two of the most advanced imaging guidance techniques available: ultrasound guidance and fluoroscopy. 

  • Ultrasound guidance: Ultrasound guidance uses ultrasound waves to give physicians real-time visuals of the placement of the needle as it travels through the skin and to the target location. 
  • C-arm fluoroscopy: This technique uses a C-shaped machine that creates real-time X-ray images of several aspects of the knee.

To ensure that the potential of these techniques is maximized and that results are interpreted accurately, each PRP injection is administered by highly trained specialists who are authorities in the field of interventional orthopedics.

Interventional Orthopedics

By making the use of imaging guidance a standard practice in our therapies, Orthagenex helped pave the way to the establishment of a new, recognized medical field: interventional orthopedics

This field of medicine is based on three key pillars: 

  • The use of injection (such as PRP) to stimulate the healing of musculoskeletal tissues 
  • The use of imaging guidance to improve needle placement accuracy and health outcomes
  • Continuous innovation and development of new, improved injectates and administration techniques. 

Lab-Processed For Higher Concentrations Of Platelets

The concentration of platelets in PRP matters. It determines the health outcomes you are likely to see from your therapy and influences your long-term knee health.

However, most orthopedic clinics use standard bedside centrifuges (spinning machines) to create their injectates. These machines are inefficient in concentrating platelets and may not be able to remove unfavorable components from the mix. To make things worse, PRP formulations are immediately injected into the site of injury, without any further customization process. 

At Orthagenex, we believe that the road to optimizing the results of PRP therapies is through tailoring each injectate to your unique needs. That is why we take advantage of ad hoc cellular lab facilities located within each of our clinics.

After collection, blood samples are lab processed, where they are concentrated and purified using state-of-the-art techniques. They are then customized to your needs and injected using imaging guidance by specialized healthcare professionals.

Here’s how the Orthagenex protocol compares to the modalities of other clinics.

Other Clinics Orthagenex
Tools used to create PPR Standard bedside centrifuges Specialized cellular lab environments where samples are purified and concentrated
Protocol to perform PRP Immediately injected to the site of the injury Further purification and customization processes before injections
Resulting concentration of platelets in PRP Maximum 2-5 times higher than “normal blood” values (2-3 times on average). 10-30 times higher than baseline values.

Amber PRP vs. Red PRP

Another aspect that sets apart the PRP therapies offered at Orthagenex is the use of amber PRP. Platelet rich plasma can appear in different colors, based on the presence of white and red blood cells, alongside platelets.

As displayed by the image above:

  • Red PRP: Red PRP (leukocyte-rich PRP or LR-PRP) contains high concentrations of platelets, but it is also rich in white and red blood cells. 
  • Amber PRP: Amber PRP (leukocyte-poor PRP or LP-PRP) contains high concentrations of platelets, and it is poor in white and red blood cells.

Both injectates contain platelets, but the presence of other blood components can make a difference. According to the lab tests conducted at Orthagenex, the presence of red and white blood cells can:

  • Cause inflammation at the site of injection
  • Have an inhibiting effect on the same stem cells PRP is attempting to stimulate 
  • Reduce the likelihood of optimal outcomes.

On the other hand, amber PRP causes less inflammation and increases the efficacy of each shot. Because of this, amber LP-PRP is the injectate of choice at Orthagenex.

Next-Generation Platelet Lysate

Injections of platelet lysate (PL) utilize similar principles as PRP, yet they represent a more advanced variant of this therapy. The specialists at Orthagenex may choose to use PL either in conjunction with or as an alternative to platelet rich plasma, based on your unique needs.

Here’s how the two compare:

Growth factors are released over time (generally a week) to the site of the injury. Peak results may take longer to appear. Growth factors are released immediately, en masse, to the site of the injury, producing a fast-acting effect.
May cause some degree of inflammation at the site of injection. It is remarkably anti-inflammatory.
Not always suitable to treat sensitive areas. Particularly suitable to treat areas (e.g. around nerves and the spinal cord).

Traditional orthopedic practices are only now starting to recognize the advantages of PL injections. On the other hand, the seasoned team at Orthagenex has been incorporating them into our treatment protocol for years. We currently provide patients with third and fourth-generation PL injections as we continue to explore and innovate in this area.

PRP Customized To Every Patient’s Need

ACL tears are incredibly common. But no two patients will have the same experience with this type of injury. For some, it is nothing more than a minor, temporary problem caused by excessive stress. For others, especially athletes and professionals, a torn ACL can mean long-term disability and career limitations.

Because of this, a “one-size-fits-all” therapeutic approach should never be considered. At Orthagenex, we ensure that each treatment plan – and each PRP injection! – is entirely customized to your needs.

To do so, we take advantage of specialized cellular lab environments and supplementary therapies such as bone marrow concentrate and platelet lysate (PL) injections. Here’s what you need to know.

Solutions Are Customized Using a Specialized Cellular Lab Environment

It’s essential to note that the purity and efficacy of PRP injections can vary. To ensure that we provide you with the highest platelet concentrations and purest injections, at Orthagenex, our specialists utilize a state-of-the-art cellular laboratory environment.

This lab platform, located in-house within every Orthagenex clinic, empowers us to tailor each injection to your specific needs. Through ad hoc lab equipment and techniques, we carefully monitor platelet concentrations and remove any undesirable elements from the injectates.

From collection to injection, each step of the process is handled by a team of specialized physicians, who are experts in cellular lab processing techniques, interventional orthopedics, and imaging guidance.

Bone Marrow Concentrate (BMC) Can Be Used

In addition to platelet-rich plasma, or PRP, we also offer BMC. BMC represents another dimension of regenerative medicine. It employs the use of imaging technology to guide injections of bone marrow concentrate – which is extremely rich in stem cells – into the injury site.

These stem cells are harvested from the liquid part of your bone marrow, which is accessed through a procedure called cannulation, from near the pelvic area. Once injected at the site of injury, BMC works by aiding the healing and regeneration and by refilling the pool of stem cells in and around damaged tissues.

Doctors Specializing In Interventional Orthopedics

As seen above, Orthagenex uses advanced machinery and techniques. But nothing of what we offer would be possible without the immense expertise, knowledge, and experience of our highly trained medical staff.

Each member of our medical team is a musculoskeletal (MSK) expert, specializing in imaging guidance. Our doctors are also board-certified and fellowship-trained in interventional orthopedics.

Today, only 1% of US physicians are trained in interventional orthopedics. Given these numbers, it is easy to see how the Orthagenex clinics have been able to help more orthopedic patients than any other regenerative medicine clinic worldwide.

Core Competencies

  • Employing advanced imaging techniques to enhance precision during the placement of PRP injections
  • Utilizing a one-of-a-kind, state-of-the-art cellular laboratory environment to create superior injectates
  • Choosing amber LP-PRP as the preferred PRP mix
  • Offering a variety of comprehensive interventional orthopedics therapies, such as PL and BMC
  • Relying on SANS – our unique proprietary assessment method.

SANS – which stands for Stability, Articulation, Neuromuscular, and Symmetry – is an innovative evaluation method that aims to overcome the challenges of accurately diagnosing chronic pain conditions and systemic inflammation.

The SANS assessment method is used at Orthagenex to determine the location, cause, nature, and extent of your condition, so that you can work with your team of healthcare providers to find a sustainable, efficient line of treatment – and, ultimately, achieve your desired health goals.

Orthagenex – Your Alternative To ACL Tear Surgery

ACL tears can take a significant toll on your ability to live life independently, carry on with your favorite activities, and even maintain your career. Fortunately, taking medications, struggling through the pain, or living in fear of having to undergo surgery are no longer the only options available.

With the help of the Orthagenex team, you can now access superior platelet rich plasma protocols that are entirely tailored to your needs. 

Take a leap forward toward knee health. Discover the Orthagenex approach.

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