ACL Repair is a valid alternative to ACL Reconstruction in appropriately chosen patients

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Abstract

Objective: In appropriately selected patients, primary repair of the anterior cruciate ligament (ACL) has demonstrated an alternative to ACL reconstruction, potentially permitting an accelerated early functional recovery and avoiding the graft site morbidity associated with an autograft harvest. This study sought to investigate clinical outcomes, RTS and re-injury rates in patients undergoing ACL repair. Methods: A total of 20 patients were consecutively recruited that fulfilled the criteria for ACL repair, undergoing surgery for Sherman grade 1-2 tears between March 2023 and March 2025. Outcomes are being collected pre-operatively and at 3-, 6-, 12- and 24-monhts post-surgery, via patient-reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) score, the Lysholm and Cincinnati scores, the Marx and Tegner activity scores, and the Anterior Cruciate Ligament Return to Sports after Injury (ACL-RSI) scale. Anteroposterior KT-1000 laxity measurements, peak isokinetic knee extensor and flexor strength, and a 6-hop test battery are being administered. Limb Symmetry Indices (LSIs) are calculated for performance measures, while RTS rates, re-tears and re-operations are documented. Results: The 20 recruited patients span the post-operatively timeline including 3 (n=1), 6 (n=3), 12 (n=9) and 24 (n=7) months. Recruitment included 11 (55%) females, with the full cohort having a mean age of 37.4 years (range 22-49) and body mass index of 24.1 (range 19.5-35.4). A significant (p<0.05) improvement to 12 months was observed in the IKDC, Lysholm and Cincinnati scores. At 6-months post-surgery, a mean side-to-side KT-1000 score of 1.8mm (range 0-4) was observed, which was not significantly different to a mean 1.6mm (range 0-3) in those assessed at 12 months. At 12 months, mean LSIs of 92.4% and 96.9% were observed for peak knee extensor and flexor torque, respectively. One patient encountered an early post-operative partial peroneal vein occlusion that was treated accordingly without issue. One patient underwent a secondary lateral extra-articular tenodesis at 8 months due to ongoing perceived instability, while one patient suffered an ACL re-injury at 13 months when re-engaging in pivoting sports. Conclusions: While post-operative clinical review will continue, ACL repair has demonstrated significant clinical improvement in an appropriately selected patient cohort