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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Article info
Publication history
Accepted:
June 21,
2019
Received:
February 26,
2019
Footnotes
See commentary on page 3328
The authors report the following potential conflicts of interest or sources of funding: M.K.M. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Ruth Jackson Orthopaedic Society. J.T.B. reports paid consultant from DJ Orthopaedics; other from Mitek; other and paid consultant from Smith & Nephew; other and research support from Stryker; IP royalties and unpaid consultant from Shukla Medical; board or committee member for Western Orthopedic Association. 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: Anterior Cruciate Ligament Repair Revisited … Do We Need A Paradigm Shift?ArthroscopyVol. 35Issue 12
- PreviewThis 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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