Identifying candidates for arthroscopic primary repair of the anterior cruciate ligament: A case-control study

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

“…In this study, it was noted that in 90% of the patients at least one ligament could be repaired. With regard to ACL injuries, Van der List et al recently assessed the eligibility of primarily repairing proximal ACL tears and found that 43.8% of all tears were repairable [47]. This was somewhat similar to the results found in the present study.…”

“…To date, however, it is unknown what the ideal timeframe for primary repair is, although the majority of published studies noted that primary repair was performed within two weeks from injury [56][57][58]. A recent case-control study found a cut-off of four weeks (OR 3.3, P b 0.001) for performing primary repair of ACL tears, indicating that surgery should be indeed performed in the acute setting when attempting primary repair [47], although some tears can also be repaired in the chronic setting when the ligament scars to the PCL and/or the tissue length and quality remains preserved [59,60]. It should be noted that surgery within two weeks is associated with postoperative stiffness [61], and it is therefore important that patients have improving range of motion and resolving irritation of the knee prior to surgery.…”

“…No significant difference was noted for the other ligaments. Recently, Van der List et al noted in a subset of patients that patients were more likely to be treated with ACL primary repair if they were 35 years or older (OR 4.2, P b 0.001) or BMI under 26 kg/m 2 (with an OR of 1.9, P = 0.029) as compared to patients treated with reconstruction [47]. To date, it remains unclear why these patients are more eligible for primary ACL repair as no studies have assessed the role of BMI and age on tear types yet.…”

Good to Excellent Functional Short-Term Outcome and Low Revision Rates Following Primary Anterior Cruciate Ligament Repair Using Suture Augmentation

“…Despite the fact that 37 patients were treated on the day of injury, we are not able to report differences compared to patients with a short delay in surgery (of up to 18 days). This is possibly due to the fact that all patients were operated on very early compared to the recommendations of previous studies [ 8 , 10 ]. Given the histological findings, we still recommend performing ACL repair as early as possible; however, considering the excellent functional results reported in the present study as well as in the aforementioned studies, a delay of several weeks up to 3 months does not appear to be clinically relevant with the numbers available.…”

“…Due to the poor biological healing capacity of the ACL with synovial fluid creating “a hostile environment” and intra-articular movements preventing the required formation of a stable fibrin-platelet scaffold, high re-rupture rates and simultaneous advancements in ACL reconstruction led to an almost complete abandonment of open ACL repair in the 1990s [ 4 , 5 , 7 ]. A resurgence of focused attention on restoring native anatomy, preservation of proprioceptive abilities and reduction in donor site morbidity have led to a renewed interest in ACL repair for patients presenting with a proximal tear pattern, with excellent tissue quality and a short delay to surgery [ 8 , 9 , 10 , 11 ]. One known surgical technique is arthroscopic ACL repair using an augmentation technique, as augmentation has been shown to have a crucial role in mechanical protection of the ACL, allowing for a self-healing response and the formation of stable scar tissue [ 11 , 12 , 13 ].…”