Annually 200,000 people in the U.S. tear their anterior cruciate ligament (ACL). The ACL, tissue that connects the shin to the thigh bone, is made of fibers that act like a stiff rubber band allowing the knee to move while holding bones together. In the world of orthopaedic surgery, there are differences of opinion as to how to repair such an injury.
Freddie Fu, MD, and chairman of the University of Pittsburgh Medical Center’s department of orthopaedic surgery, and a McGowan Institute faculty member, supports a knee surgery he learned from Japanese surgeons and pioneered in the U.S.—called the “double-bundle” procedure. Most surgeons today perform a “single-bundle” procedure, and after extensive research Dr. Fu now disagrees with that approach.
In support of his research and in partnership with the Pittsburgh Zoo & PPG Aquarium and the Carnegie Museum of Natural History, Dr. Fu operated on a mandrill monkey—a first ever procedure that he hopes will help humans as well. The surgery to repair the 12-year-old, 99-pound monkey’s knee provided an opportunity to explore his theory by closely examining its ligaments and structure.
There are two bundles of fibers in the knee—one that allows the knee to bend, the other that allows the knee to twist. Typically doctors repair one bundle of fibers, but Dr. Fu contends that effective knee surgery must replace both bundles.
“You’re born with two bundles, you live with two bundles, and you die with two bundles,” Fu said. “But when you get surgery, then you have only one bundle.”
In addition to gathering data on long-term outcomes of patients who get double-bundle ACL repairs, Dr. Fu is mining the fossil record at the natural history museum to trace the evolution of the double-bundle. Dr. Fu has learned that even the 50 million-year-old knee of the extinct Shoshonius—a big-eyed monkey weighing only a few ounces—had a double-bundle. Tiny “bony landmarks” on fossilized knee bones stored at the Oakland museum show where the ligaments were attached.
Illustration: Pittsburgh Zoo and PPG Aquarium.
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