Primary anatomical repair of proximal acl ruptures with suture anchors: 1 year follow-up

Abstract

Aims and Objectives: ACL injuries are common. Going trough the literature, numerous studies show a healing potential for the repair of acl tears, histologically comparable to mcl healing. In this study, the postoperative follow-up after acl preservation was examined up to 1 year. Materials and Methods: We performed a prospective clinical follow-up in 13 sportive patients (case series, no comparison group). Inclusion criterias were a proximal avulsion tear of the acl, patient age under 50 years and surgery within 6 weeks after trauma. In an arthroscopic procedure, the quality of the acl tissue was examined and judged if suitable for a repair. Concomitant injuries were treated at the same time. Using a suture passer, a Bunnell stitch was created with a nonabsorbable suture through the anteromedial bundel as through the posterolateral bundel. The footprint of the acl was prepared with an awl for liberation of stem cells. The bundels were reattached to the origins of the footprint with two absorbable suture anchors. No drain was used. The postoperative protocoll was as follows: partial weight bearing for 4 weeks and wearing a protective brace with a limitation for extension and flexion of 0-0-90° for 4 weeks. At week 5, the brace was unlocked and range of motion and weight bearing were gradually increased at the level of comfort. Patients were examined at 6 weeks, 3 months, 6 months and 12 months after surgery. The stability was tested with the KT 1000, the subjective outcome with the ACL-RSI and the clinical outcome using the Tegner activity score, the Lysholm score, the KOOS score and the IKDC objective form. X-rays were done after 3 and 12 months, a MRI after 6 months. Between months 4 and 6, patients returned to their previous level of sport. Results: All 13 patients have been included in the 1 year follow-up. No rerupture was seen. There have been no major complications, as minor complications we observed 2 effusions of the knee 7 days after surgery which were treated with aspiration. The patients presented the following outcomes after 1 year: the mean anterior translation difference in the KT 1000 was 0,85 mm; the median Tegner activity score was 6 (range from 5 to 9); the median Lysholm score 95,9; the median KOOS was 94,5. The IKDC was A in 9 of 13 patients, B in 3 and C in 1 patient. The ACL-RSI in the 6 week follow-up was 64,14%, indicating a high level of subjective stability and confidence. This score increased gradually to the 1 year follow-up (94,5%). X-rays showed no pathologic bone signal or tunnel widening. MRI showed appropriately positioned and continous ligaments with scar tissue and an irregular signal due to suture material. Conclusion: In this study, the results 1 year after surgery with an anatomical repair of the acl are promising. Nearly all patients returned to their previous sports level, indicating healing potential for acl injuries. If patient selection is done carefully, this technique is a supplement in the treatment algorithm of acl injuries.