Dr Varacallo with patient
Cayleigh Walker (center) is shown with Dr. Matthew Varacallo and Samantha Morgan who helped her return to normal faster following surgery to repair her torn ACL using the innovative Fertilized ACL procedure at Penn Highlands DuBois.

Penn Highlands Healthcare Surgeon Pioneers Innovative ACL Surgery Offering Faster Recovery

Cayleigh Walker’s hopes for a successful basketball season were almost benched when she tore her ACL playing summer league basketball at the YMCA in July 2021. However, the Clearfield (Pennsylvania) High School sophomore resumed training just three weeks following her August surgery fast tracking her return to the court with the Lady Bison varsity basketball team.

“I was going up the court and felt it pop,” Cayleigh recalled. “I was in so much pain. I had to sit out the rest of the game while some of the parents tried to stretch it out. I was eager to have it examined because we were leaving for the beach two days later. Fortunately I was able to get an appointment to have it examined the next morning.”

Cayleigh and her parents chose Penn Highlands Orthopedics and Sports Medicine for her care. At Penn Highlands, she was examined by Tyler Beers, PA-C, who tested her range of motion and felt around the injured area. He gave her a brace to wear and ordered an MRI which was scheduled the following week when the Walkers returned from their vacation.

The MRI revealed the torn ACL. The next day, Cayleigh met with Dr. Matthew A. Varacallo, medical director of Orthopedic Robotic Surgery at Penn Highlands Healthcare. The orthopedic surgeon specializes in sports medicine, total joint reconstruction, accelerated rehabilitation protocols and functional return to sports after surgeries and procedures.

Named to the “Top 65 Total Knee Replacement Surgeons to Know” by Beckers’ ACS Review, Dr. Matthew Varacallo pioneered the innovative Fertilized ACL technique along with Dr. Chad Lavender, an orthopedic surgeon at Marshall University in West Virginia. Currently, they are the only two surgeons in the US using the technique when performing ACL reconstruction surgery.

“Typically, when an ACL tear occurs, one third of the athletes re-tear the same side or injure the other knee; but, the theory behind the Fertilized ACL technique is to improve and expedite bone tunnel healing rates, followed by graft revascularization and ligamentization (the process by which the tendon becomes a ligament) to improve graft function and incorporation into the knee joint,” explained Dr. Varacallo.

The Fertilized ACL procedure begins when bone marrow is removed from the tibia — the long bone on the inside of the lower leg -- which is rich in growth hormone and stem cells. A specialized perfusionist takes 60 milliliters of the bone marrow and spins it down to bone marrow aspiration concentrate (BMAC) which is used to initiate healing. The BMAC is mixed with bone graft. Small tunnels are then made in the femur and tibia to place the graft during the procedure. The bone graft mixture and stem cells/growth factors are then injected into the tunnels to help stimulate them to heal faster. Once the tunnels heal, the tendon can in theory possibly transform into a ligament faster.

“This is truly a cutting edge procedure,” explained Dr. Varacallo. “In traditional ACL surgeries, the pressurized tunnels can be risk factors for re-injury because they can take up to six or seven months to heal. However, with the Fertilized ACL procedure, the tunnels heal faster because the graft starts to incorporate into the body faster. In fact, four weeks post surgery, you cannot even see the bone tunnels,” the surgeon added.

Dr. Varacallo considers Cayleigh the poster child for successful ACL reconstruction because she is achieving milestones sooner than expected, and Samantha (Sam) Morgan, MS ATC PES, a certified athletic trainer with Penn Highlands Healthcare as well as with the Clearfield Area School District agrees.

“Three days following surgery, Cayleigh began rehab, and at three and one half weeks post op she was running, and six to seven weeks following surgery she was punting a soccer ball. In contrast, with traditional ACL surgery, we would not see that type of progress until three or four months post op,” Ms. Morgan detailed.

According to Dr. Varacallo, Cayleigh is several months ahead of where she should be in terms of her progress based on the functional testing ACL Report Card, The Report Card, which is used to measure how well a patient is meeting 15 different functional test milestones at two, four, six and eight months post op, was developed at the University of Kentucky where Dr. Varacallo completed his fellowship in Orthopedic Surgery and Sports Medicine.

“The ACL Report Card is a great benchmark tool because it not only shows the medical team the patient’s progress, it gives the athlete something to shoot for in their rehab,” said Dr. Varacallo.

“I had four months of rehab five days a week,” Cayleigh said, “The first few weeks were challenging because I was in some pain, but Sam pushed me and helped me get through it.”

At two months after surgery, Cayleigh was testing stronger on the surgery side than on the other non-injured side. One of the factors that contributed to her faster recovery was that prior to surgery she and the other patients who have Fertilized ACL reconstruction surgery have “prehab,”

“We cannot operate on a stiff and weak knee, so prior to surgery, we have the patient undergo motion and strengthening exercises to improve outcomes following surgery,” Dr. Varacallo explained. “The stronger the knee heading into surgery, the faster the recovery.”

In addition to enhancing flexibility, prehab teaches patients the exercises they will be doing during post-surgery rehab so that they are already familiar with what their physical therapy will entail.

“Cayleigh had aggressive prehab,” said Ms. Morgan. “In addition to promoting flexibility of the knee, it is an educational tool that helps the patient understand the “how” and “why” of the injury and healing. Three days following surgery, Cayleigh started rehab, and because she had the prehab, she already knew how to perform her exercises.”

The prehab, surgery and rehab are all interdependent on each other. In fact, Dr. Varacallo uses an analogy to tie the process together. “I think of the reconstruction and healing process as a house – the prehab is the foundation, surgery is the main living level and rehab is the attic.”

Ms. Morgan pointed out that the Penn Highlands’ program follows a holistic approach to rehab to reduce the likelihood of re-injuries. An individualized plan is created for each patient based on their specific sport. Cayleigh’s personalized plan included three separate days each week devoted to a different regimen including strength, cardio and functional.

According to Cayleigh’s mother, Tammy Walker, her daughter’s fast recovery is a combination of three factors, Dr. Varacallo’s innovative Fertilized ACL technique, the aggressive rehabilitation and equally important the determination by Cayleigh and Sam Morgan to get her back to where she could play again.

“We are very impressed with Dr. Varacallo,” said Mrs. Walker. “He was very thorough and went through everything with us and even called to check on her progress following the surgery.”

Word is quickly spreading that the Fertilized ACL technique is offered in Central Pennsylvania. Dr. Varacallo’s schedule is filling up with athletes as well as people in their 30s, 40s and 50s who want to have ACL reconstruction surgery using this innovative technique. The surgery has been performed already on many college and high school athletes throughout the entire region.

Dr. Varacallo’s concern for his patients goes beyond the operating room. Even though he is busy, he still found the time to attend Cayleigh’s first scrimmage after he cleared her to play. According to Cayleigh, while the Lady Bison basketball team started out “shaky,” the team has found their rhythm now. Personally, she is not missing a beat; she was recently named “One of the Top 30 Scorers” among hundreds of high school players in Districts 9 and 10.