A Comparative study of anterior cruciate ligament repair effectiveness in proximal ACL tears

Abstract

Background. Anterior cruciate ligament (ACL) reconstruction is a gold standard surgical option for ACL tears. Another go-to method is primary ACL repair. The latter has its own limitations such as small range of indications – proximal tears only, which constitute a significant portion of ACL injuries. Although the primary repair has been known for a long time and is still developing, recent publications show conflicting outcomes. Aim of study was to compare functional outcomes of patients with ACL reconstruction and primary repair. Methods. During 2020-2023 we conducted randomized prospective multicenter control comparative study which included 170 patients with ACL tear types A, B, E according to Gächter classification, with injuries no older than 3 months. Patients were divided into two groups: 1st group – primary repair of ACL, 2nd group – ACL reconstruction. Knee function was assessed before surgery and 3, 6, 12, 24 months after the treatment using the IKDC 2000 and Lyshlom Knee Score. Results. Type E ACL injury prevailed in the sample. The most common associated injury in both cohorts was medial meniscus tear (39,3±0,05% and 45,3±0,05%). 15,5±0,04% patients with primary repair had chondrolabral defects, reconstruction group – 10,5±0,03%. 46,03±0,06% of 2nd and 25,35±0,05% of 1st group (p0,05) received pain relief therapy in the form of opioid analgesics. The proportion of patients requiring reoperation for ACL injury in 1st group was 3,5%, in 2nd group – 1,2%. Both groups had a statistically significant increase in functional outcomes at 3, 6, 12 months (p0,05). The difference of knee function between groups was not statistically significant (p0,05). Conclusion. Primary ACL repair still retains a large number of limitations: it cannot and should not replace ACL reconstruction, but should be used with strict adherence to the indications and surgical technique to show comparable functional outcomes.