The Classic from John Feagin and Walton Curl (1976) on the 5-year follow-up of the repair of the isolated tear of the anterior cruciate ligament. Is there a role for ACL repair in 2016?

Abstract

‘Nothing ruins good results like long term follow-up.’Author unknownAbout 43 years ago, 2 bright young academic orthopaedic team doctors decided to review the results of anterior cruciate ligament (ACL) repair in their West Point cadet population. These initial results seemed very promising (greater than 80% good-to-excellent outcomes) at the 2-year follow-up published as an abstract in the Journal of Bone and Joint Surgery in 1972; however, instead of resting on their 2-year outcomes, they made the decision to look at this same group 5 years after surgery. What they found was very alarming and humbling in that the majority of this population had poor outcomes. Being of the highest moral integrity and calibre, they wrote up their results and submitted it to the American Journal of Sports Medicine in 1976. Ironically, the editor of the journal was the legendary Jack Hughston who was well known not to be an advocate of ACL surgery. This article most likely further fuelled his beliefs (‘gasoline on the fire’, so to say!). Since this publication over 40 years ago, there has been an explosion of basic science and clinical papers on ACL anatomy, biomechanics, healing, injury and surgical techniques. The purpose of revisiting this ‘Classic’ article is to acquire perspectives from both the original authors, Dr John Feagin and Dr Walton Curl, in conjunction with Dr Martha Murray, who is considered one of the leading experts on the science of ACL repair. This article begins with a detailed review of this ‘Classic’ and highlights the main take home points. Next, there is a discussion about the historical perspectives, the scientific and societal impact, and where we are today with basic and clinical science studies. We conclude with where we are with ACL repair in 2016 and make recommendations based on current evidence for this procedure in the spectrum of ACL surgery. The ultimate goal of this review is to expose our readership to the potential use of these techniques for select patients with ACL injuries. Most importantly, one must not overlook the primary take home message of this ‘Classic Revisited’, that careful and honest long-term follow-up is the key to evidence-based medicine.