Summary

ACL arthroscopic primary repair technique can achieve clinical success in a selected subset of patients

Abstract

Introduction

The discussion of primary repair of the ACL was historically abandoned although the results of ACL repairs were initially promising. Due to inconsistent midterm results of such repairs steered the field in the direction of augmentation and, eventually, reconstruction and no further refinement was pursued. However, risks associated with reconstruction such as loss of native tissue proprioceptive properties, physeal disruption, donor-site morbidity, and graft-associated infections exist. In light of the limitations of our current reconstructive techniques and their associated morbidity, we aimed to revisit the discussion regarding primary repair for certain carefully selected ACL injuries. The objective of this work was to show our results in primary anterior cruciate ligaments repairment.

Methods

We performed a retrospective review and follow-up of 7 consecutive cases of ACL preservation. Patients were included if they had a proximal avulsion tear and excellent tissue quality confirmed to be adequate for repair during arthroscopy. Patients were excluded if these criteria were not met or if patients had multiligamentous injury patterns or significant condral lesions. The ACL was attached with a No. 2 FiberWire (Arthrex, Naples, FL) and was anchored to the femoral footprint trough a 4mm femoral tunnel and fixated on the lateral cortex with an open attachable Button System (Arthrex, Naples, FL). The surgical procedures were performed at the same hospital by a single surgeon. Anterior stability was determined with manual testing and compared with the other side. Clinical outcomes were measured using the Lysholm score, modified Cincinnati score, Tegner activity score, Single Assessment Numeric Evaluation, and subjective and objective International Knee Documentation Committee (IKDC) scores.

Results

all patients amateur athletes, 71% male and the mean age was 20. Six of seven patients had good to excellent subjective and clinical outcomes after ACL preservation surgery at a minimum of 1,5 years and mean of 2 years follow-up. The mean Lysholm score was 94.3; the mean modified Cincinnati score was 92.3; the preoperative Tegner activity score was maintained postoperatively in 6 of 7 patients; the mean Single Assessment Numeric Evaluation score was 91.6; the mean subjective IKDC score was 87.3; and the objective IKDC score was A in 6 of 7 patients and B in 1 patient. Anterior stability with manual testing showed a difference of less than 3 mm on 6 patients and a 6-mm difference in 1 patient. We believe that the patient with the negative outcome occurred due to a short period of return to sports activity.

Conclusions

Preservation of the native ACL using the described arthroscopic primary repair technique can achieve short-term clinical success in a carefully selected subset of patients with proximal avulsion-type tears and excellent tissue quality.