Primary Repair of Anterior Cruciate Ligament Tear

Abstract

Background Initially, authors reported deterioration in the outcomes of ACL open primary repair. Consequently, authors considered ACL reconstruction surgery as the gold standard approach in treating ACL injuries. Recently, with the introduction of modern-day technology such as MRIs and arthroscopic repair, emerging reports gained interest in reevaluating the outcomes of primary repair. Aim of the Work We aim to evaluate to evaluate the results of different techniques regarding ACL repair, and determine the ideal candidates for this procedure Patients and Methods We conducted an electronic search via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till August 2020. We included randomized, nonrandomized trials, prospective or retrospective cohort and case control studies that were published in English with full text available. We restricted our search to patients diagnosed with acute ACL tear whom underwent open or arthroscopic ACL repair. Outcomes of interest were Functional outcomes (Lysholm, Bivot and Lachman scores), complications and failure rates. Results From a total 2089 screened citations, 24 studies met our inclusion criteria. Eleven studies evaluated primary ACL suture repair of the (1 study used a biologic scaffold in the ACL repair, 4 used microfracturing techniques, and 5 used some form of mechanical augmentation). The remaining 11 studies used dynamic intraligamentary stabilization (DIS). There was male predominance across the studies, with patients aged between 6 to 43.3 years and patients were follow-up to 16 years. There was a wide range of ACL repair survivorship between 60 % and 100% with reoperation rate ranged between 0 % and 51.5%. Re-rupture of the ACL, revision ACLR procedures, and implant removal were as high as 18.2%, 20%, and 100%, respectively. However, results were improved when ACL repair was combined with biological enhancers e.g. microfracturing and scaffolding. In the four comparative studies (primary repair vs. ACLR), there was no significant difference between both approaches regarding; IKDC, Lysholm, Tegner and Lachman, scores.but ACLR was slightly superior in certain outcomes e, g, failure rates and proper positioning. Conclusion We found that still ACL reconstruction is superior to ACL primary repair however, with strict selection criteria mainly; proximal ACL rupture and excellent tissue quality, primary ACL repair could be reconsidered as an effective treatment especially when combined with microfracturing and scaffolding.