Results with primary repair of the avulsed anterior cruciate ligament and internal fiber ligament augmentation

Abstract

Introduction: ACL repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. Modern arthroscopic surgical instrumentation has made repair of ACL tissue easier and advancements in functional tissue engineering and regenerative medicine have resulted in a renewed interest in ACL repair. This is an attractive option to restore normal patient anatomy, retaining proprioceptive fibers, and not causing donor site morbidity that can be associated with reconstructions. Material & Methods:The study included 10 consecutive patients who presented with traumatic ACL avulsions (including bony avulsions) in outpatient or emergency department in last 2 years. Our inclusion criteria were cases with primary ACL injury (avulsion / proximal or distal end) not exceeding 3 months. Patients with severe arthritis of knee, multiligamantous ligament injury, history of previous surgery, bleeding disorders, any comorbidility leading to a non-operable condition were excluded from the study. Results: Out of 10 cases three cases had an avulsion from femoral end while seven had it from the tibial end. The injury surgey interval was in a range of six days to sixtythree days. Post operatively four patients had restriction of knee extension (5 degrees) at 4 weeks follow up. Rest of the cases had attained full range of motion at four weeks. All the cases had pain free gait pattern but needed aggressive physiotherapy to reinforce the normal gait pattern. There was no clinical ACL laxity in any of the cases, whenever seen at routine follow ups Conclusion: The internal brace acts as secondary pillar which supports the strength of the repaired ligament. Patients have a better proprioception, faster recovery to work & are safe guarded against an unpredictable outcome of ACL reconstruction.

Balanced, biologic, and cost-effective technique for anterior cruciate ligament tibial avulsion repair: A 15-step novel approach

“…Work done by Agrawal et al has used fiber tape as internal brace after primary fixation by fiber wire. [10] Strangulation technique using fiber tape has been reported for tibial spine avulsion fractures fixation. [11] Presented technique of balanced and biological repair can help early mobilization without interfering with biology or stability of repair construct.…”