Abstract
BackgroundRecently, there has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury.Patients and methodsA consecutive series of patients with acute ACL tears were prospectively included in the study. Based on MRI appearance, ACL tears were classified into five types, and tissue quality was graded as good, fair, and poor. Patients with type I, II, and III tears and at least 50% of ACL tibial remnant intact with good tissue quality were ultimately included. Clinical outcomes were measured using the Tegner Lysholm Knee Scoring Scale (TLKSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), subjective and objective International Knee Documentation Committee (IKDC) scores, and KT-1000. Patients were also followed up with MRI evaluations at 1, 3, and 6 months postoperatively. ACL appearance was graded based on morphology (normal or abnormal) and signal intensity (isointense, intermediate, and hyperintense).ResultsThe mean TLKSS was 98.1, the mean subjective IKDC was 97.6, and the mean KOOS was 98.2. The objective IKDC score was A in eight of ten patients and B in two patients. KT-1000 measurements showed a maximum manual side-to-side difference of less than 2 mm in eight of ten patients, whereas two patients showed a difference of 3 mm. The morphology of the repaired ACL was normal (grade 1) at 1 month follow-up in ten of ten cases, and this appearance persisted at 3 and 6 months postoperatively. The signal intensity at 1 month postoperatively was graded as isointense (grade 1) in four of ten patients, intermediate (grade 2) in five of ten patients, and hyperintense (grade 3) in one of ten patients. At both 3 and 6 months postoperatively, the signal intensity was graded as isointense (grade 1) in nine of ten patients and intermediate (grade 2) in one of ten patients.ConclusionsArthroscopic primary ACL repair performed acutely in a carefully selected group of patients with proximal ACL tears and good tissue quality showed good early clinical and radiological results.Level of evidenceLevel 4.
Highlights
IntroductionOpen primary repair of acute anterior cruciate ligament (ACL) injuries (< 2 weeks from injury) was the standard treatment for ACL injuries until the middle to the late 1980s
Anterior cruciate ligaments (ACL) tears represent one of the most frequent orthopedics and sports medicine injuries in the athletically active population and often resultOpen primary repair of acute anterior cruciate ligament (ACL) injuries (< 2 weeks from injury) was the standard treatment for ACL injuries until the middle to the late 1980s
Five were excluded, and they subsequently underwent ACL reconstruction with a hamstring graft. This left a total of ten patients who were treated with arthroscopic primary ACL repair and composed the study group
Summary
Open primary repair of acute ACL injuries (< 2 weeks from injury) was the standard treatment for ACL injuries until the middle to the late 1980s. It is likely that inaccurate patient selection that treated all tear types in the same way, higher morbidity surgical techniques performed through open arthrotomies, and old-fashioned rehabilitation protocols focused on early cast immobilization negatively affected the outcomes of ACL repair in this early era of ACL surgery [6,7,8]. There has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury
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