Anterior Cruciate Ligament (ACL) Primary Repair

Overview

ACL rupture occurs in hundreds of thousands of active adolescents and young adults each year. While many ACL tears are treated successfully with standard ACL reconstructive surgery, the pain and morbidity associated with graft harvest, and length of time to full recovery from surgery remain areas I need of improvement. Additionally, arthritis development is commonplace within a decade of injury in young patients treated with standard ACL reconstruction.

Made Possible by Progress

The technique of primary ACL repair was largely abandoned by the mid 1990’s due to marginal clinical outcomes and the thought that the ACL has poor potential to heal. However, careful analysis reveals that certain subgroups, especially proximal tears with good tissue quality, had better clinical outcomes than the group as a whole. In light of the advances in diagnostic imaging, arthroscopic surgical technology, and developments in rehabilitative treatment, primary ACL repair is an emerging concept that is a great alternative for select patients.

The Advantages of Primary Repair

Primary repair has significant potential advantages over current ACL reconstruction techniques, including the preservation of the complex attachment sites and innervation of these structures, which leads to retaining much of the biomechanical and proprioceptive function of these tissues. More specifically, modern MRI imaging can now pre-operatively identify tears that are amenable to repair. Surgical instrumentation now exists that allows anatomic restoration of the normal ACL with robust fixation, allowing for aggressive and effective rehabilitation.