Primary repair vs arthroscopic reconstruction for proximal anterior cruciate ligament tears: a comparative study

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Background. Anterior cruciate ligament (ACL) reconstruction is the gold standard surgical option for ACL tears. Another treatment method is primary ACL repair. The latter has some limitations such as a small range of indications — proximal tears only. However, they still 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 opinions regarding its application. The aim of study is to compare functional outcomes of patients who underwent anterior cruciate ligament reconstruction and primary repair. Methods. In the period from 2020 to 2023, we conducted randomized prospective multicenter control comparative study, which enrolled 170 patients with the ACL tear types A, B, E according to the Gächter classification. The injuries were no older than 3 months. The patients were divided into two groups: Group 1 — primary repair of the ACL, Group 2 — standard technique of the ACL reconstruction with a tendon autograft. Knee function was assessed before surgery and 3, 6, 12, 24 months postoperatively using the IKDC 2000 and Lysholm Knee Score. Results. Type E of 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% for Group1 and 2, relatively. Chondrolabral defects were observed in 15.5±0.04% of patients with primary repair, and in 10.5±0.03% of patients from the reconstruction group. Pain relief therapy in the form of opioid analgesics received 46.03±0.06% patients in Group 2 and 25.35±0.05% in Group 1 (p0.05). The proportion of patients requiring reoperation for ACL injury in Group 1 was 3.5% and 1.2% in Group 2 (p0,05). Both groups had a statistically significant increase in functional outcomes according to the scales at 3, 6, 12 months (p0.05). The difference in knee function between the 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. However, with strict adherence to the indications and surgical technique, primary ACL repair demonstrates comparable functional outcomes.