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Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears: No Deterioration at Mid-Term Follow-Up

      Introduction

      Open primary repair of the anterior cruciate ligament (ACL) was a popular surgical treatment for ACL injuries in the 1970s and 1980s. Although the short-term outcomes were excellent, the results deteriorated at mid-term follow-up, which ultimately led to the abandonment of open primary repair. Recently, however, excellent short-term outcomes of primary repair using arthroscopy in 11 patients with only proximal ACL tears have been reported with one failure (9%) and good clinical outcomes. Goal of this study was to assess the mid-term outcomes of these patients.

      Methods

      The first 11 consecutive patients with proximal avulsion tears and excellent tissue quality treated with arthroscopic primary repair were evaluated at mid-term follow-up. Physical examination and laxity examination were performed and patients completed several outcome questionnaires.

      Results

      Eleven patients were seen at mean follow-up of 5.6 years (range: 4.2–8.4 years). No patients had failure of the repair besides the earlier failure at short-term follow-up (9%). One additional patient (9%) underwent reoperation for a medial meniscus tear. The other ten patients had full range of motion, negative Lachman test, eight patients had a negative pivot shift and two patients +1 pivot shift. IKDC objective score was A in 8 patients and B in 2. Lysholm was 97 (range 92-100), modified Cincinnati 97 (range 87-100), mean SANE score 96 (range 90-100), preinjury Tegner 7.2 (range 5-9), and postoperative Tegner 6.8, (range 3-9) and IKDC subjective score 95 (range 82-100). Seven patients had a MRI that showed ligament continuity.

      Conclusion

      Historically, studies showed that the results of open primary repair deteriorated at mid-term follow-up. With appropriate patient selection (only treating patients with proximal tears and excellent tissue quality) and arthroscopy, results in this study did not deteriorate at mid-term follow-up. Arthroscopic primary repair of proximal ACL tears is an excellent, minimally invasive treatment option in these patients.