A Hybrid Repair Technique Combining Single-Bundle Reconstruction and Primary Repair With Internal Brace Augmentation for Anterior Cruciate Ligament Injury

Abstract

Recently, favorable outcomes of primary anterior cruciate ligament (ACL) repair have been reported in patients with proximal tears and good tissue quality. If the tear involves the midsubstance of the ACL fibers or Sherman type II or III injury, independent primary repair will cause a higher failure rate at long-term follow-up. For these cases, we conduct primary repair and apply an internal brace and single-bundle reconstruction as hybrid augmentation. This hybrid repair technique encourages natural healing of the primary ligament by the internal brace and single-bundle graft as a provisional scaffold during the healing phase, as well as early mobilization. We describe our ACL hybrid repair technique, using a video and illustrations.

Arthroscopic Anterior Cruciate Ligament Primary Repair With Synthetic Augmentation and Fixation With the Knotless Suture Anchor

“… 20 , 21 , 22 Recently, there have been many published surgical techniques for ACL repaired with internal brace augmentation. 23 , 24 , 25 The internal brace technique is classified into two types: augmentation (using suture material to augment the graft and set tension together with the graft) and reinforcement (setting tension separately with the graft). 26 This surgical technique employs the reinforcement principle by adjusting the tension of the internal brace independently of the native ACL.…”

Rehabilitation Principles to Consider for Anterior Cruciate Ligament Repair

“…38,52,91 The stability and strength provided by internal bracing is not limited to primary repair and variations in the technique have been described as well. 50,79,84,87 Internal bracing is reserved for Sherman type I proximal ruptures with good tissue quality. 52…”