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Primary Arthroscopic Repair of the Anterior Cruciate Ligament: A Systematic Review of Clinical Outcomes

      Purpose

      To describe the clinical outcomes after primary arthroscopic anterior cruciate ligament (ACL) repair.

      Methods

      A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the PRISMA guidelines. All English-language literature published from 2000 to 2018 that reported the clinical outcomes after primary arthroscopic repair (AR) of complete tear of the ACL (without augmentation) with a minimum 2-year follow-up was reviewed by 2 independent reviewers. Outcomes included repair failure, reoperation, postoperative knee stability, and patient-reported outcomes. Descriptive statistics are presented. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Nonrandomized Studies (MINORS) score.

      Results

      Six studies (2 level III, 4 level IV) were included. The mean MCMS was 62.2. The mean MINORS score for noncomparative studies was 11.8, and for comparative studies, 18. Six studies reported outcomes of 89 patients who underwent AR of the ACL from 2007 to 2016 (age, 8 to 67 years; follow-up, 24 to 110 months). All 6 studies included exclusively proximal avulsion tears. Overall, 0% to 25.0% of patients experienced repair failure (I2 = 23.7%; 95% confidence interval, 0% to 67.6%), and 0% to 20.0% of patients had a subsequent reoperation (I2 = 12.1%; 95% confidence interval, 0% to 77.7%). Similar inconsistent results were shown for postoperative knee stability measures and patient-reported outcomes.

      Conclusions

      The literature on clinical outcomes of primary arthroscopic ACL repair is limited. The reported rates of repair failure and reoperation are highly inconsistent. Most studies report relatively high failure rates.

      Level of Evidence

      IV, systematic review of level III and IV studies.
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      Linked Article

      • Editorial Commentary: Anterior Cruciate Ligament Repair Revisited … Do We Need A Paradigm Shift?
        ArthroscopyVol. 35Issue 12
        • Preview
          This commentary discusses a brief history of anterior cruciate ligament (ACL) repair using a variety of techniques, including open primary repair, arthroscopic repair, and bridge-enhanced ACL repair. Concerns are raised about the current reported outcomes of primary ACL repair. There is a need for controlled prospective studies that assess the structural integrity of the repaired ligament using modern imaging techniques, physical examination, and KT-1000 testing. Caution should be used when interpreting published studies that rely solely on patient-reported outcome measures.
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