Purpose
To critically review recent literature on outcomes following primary surgical repair
of the anterior cruciate ligament (ACL).
Methods
In December 2018, a search of the MEDLINE database was conducted for English language
articles reporting clinical outcomes of ACL repair from 2003 to 2018. Included studies
were evaluated for patient demographics, patient-reported outcome measures, return
to sports/work, patient satisfaction, and postoperative complications. Subgroup analysis
was conducted for studies that included patients with only type 1/proximal ACL ruptures.
Results
Twenty-eight studies satisfied the inclusion criteria, comprising 2,401 patients (52.3%
male, 35.7% female, 12.0% unspecified gender) with mean age ranging from 6.0 to 43.3 years.
Most studies were conducted in Europe (82.1%), were level of evidence IV (60.7%),
and were designed as case series (57.1%). Fourteen investigations (50.0%) used primary
suture repair and 14 (50.0%) used dynamic intraligamentary stabilization. Preoperative
ranges for Lysholm, International Knee Documentation Committee Score subjective, and
Tegner scores were 28 to 100, 94.1 to 100, and 2 to 9, respectively. Postoperative
ranges for the same measures were 80 to 100, 54.3 to 98, and 3.67 to 7, respectively.
Time to return to sport/work ranged from 3.1 ± 3.3 to 17.4 ± 1.5 weeks. Frequency
of rerupture, revision ACL surgery, and overall reoperations were as high as 23.1%,
33.3%, and 51.5%, respectively. Overall ACL repair survivorship ranged from 60.0%
to 100.0%. In subgroup analysis for proximal ruptures treated with repair, the rates
of revision ACL reconstruction (ACLR) and total reoperations were as high as 12.9%
and 18.2%, respectively.
Conclusions
Based on our cumulative findings across 2,401 patients from the 28 included studies,
it appears that ACLR results in better survivorship and patient-perceived postoperative
improvement when compared with ACL repair. At present, ACLR appears to remain the
superior treatment strategy in the vast majority of cases.
Level of Evidence
Level IV, systematic review of Level II to IV studies.
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Article info
Publication history
Accepted:
April 7,
2019
Received:
December 31,
2018
Footnotes
See commentary on page 2248
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Back to the Past—Anterior Cruciate Ligament Repair RevisitedArthroscopyVol. 35Issue 7
- PreviewThere has been increasing scientific interest in primary anterior cruciate ligament (ACL) repair in recent years. The results of these procedures have improved significantly compared with the 1970s and 1980s. Nevertheless, the overall rerupture rates after ACL repair are worse than after ACL reconstruction, and patient-reported outcome measures do not improve after ACL repair, in contrast to those after ACL reconstruction. However, because primary ACL repair is performed in the acute phase, improvement in patient-reported outcome measures after surgery is not expected.
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