Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation

Abstract

Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. In hindsight, however, appropriate patient selection (i.e. proximal tears and good tissue quality) was not performed, because it has recently been recognized that good outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with modern-day advances, arthroscopic primary repair can be an excellent treatment option for patients with proximal tears. Preserving the native ACL has several advantages, including maintaining native proprioceptive function and biology. The procedure is also minimally invasive and prevents the need for formal ACL reconstruction. Recently, it has been suggested that additional suture augmentation of the primary repair technique may be beneficial for protecting ligament healing during early range of motion. In this Technical Note, we present the surgical technique of arthroscopic primary repair with suture augmentation for patients with proximal ACL tears.

Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement

“… 18 Promising outcomes have also been seen in conjunction with medial knee injuries 19 , 20 and ACL repairs. 21 , 22 Recently, Bachmaier et al. 23 investigated independent suture tape reinforcement of soft tissue grafts for ACL reconstruction.…”

The multiple ligament-injured knee: When is primary repair an option?

“…The primary repair techniques for ACL and PCL tears will be discussed here, but have been previously described in more detail [18,32,33]. ACL and PCL repairs were all performed arthroscopically, using a Scorpion suture passer (Arthrex, Naples, FL).…”

How to Succeed in Arthroscopic Anterior Cruciate Ligament Primary Repair? Step-by-Step Technique

“…Isolated arthroscopic primary repair is only suitable for patients with proximal ACL avulsion (Sherman type I or eventually type II tears 6 , 14 ) ( Fig 1 ) and adequate tissue of good quality allowing an effective reattachment of the remaining ligament to the femoral wall. This is mainly seen in the subacute phase (i.e., between 2 weeks and 3 months 7 , 8 , 12 ) when the surgery is carried out but is also seen in chronic ACL ruptures if the ACL is scarred to the posterior cruciate ligament. 14 …”

“…Clinical outcomes might be further improved by the use of 2 emerging concepts: (1) biological adjunct of a collagen-based scaffold placed into the notch to improve the healing potential of the ACL repair and (2) positioning of an internal brace, which is reported to biomechanically protect the ligament during the healing phase. 4 , 9 , 10 , 11 , 12 …”