Arthroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing
Recent outcomes of arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears have been promising in small cohort studies. The purpose of this study was to assess outcomes of arthroscopic ACL repair in a larger cohort and to assess the role of additional augmentation.
The first 56 consecutive patients that underwent arthroscopic ACL repair were examined at minimum 2-year follow-up. The latter 27 patients [48.2% (27/56)] received additional internal bracing with ACL repair. All 56 patients were included (100% follow-up). Mean age at surgery was 33.5 ± 11.3 years (59% male) and mean follow-up 3.2 ± 1.7 years. Clinical examination was performed using the objective International Knee Documentation Committee (IKDC) form. Subjective outcomes were obtained using the Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation (SANE), and subjective IKDC scores.
Six repairs (10.7%) failed and four additional patients underwent reoperation (7.1%): two for meniscus tears and two for suture anchor irritation. Objective IKDC scores were A in 38 (73%), B in 8 (15%) and C/D in 6 (12%) patients. Mean Lysholm score was 94 ± 7.6, modified Cincinnati 94 ± 8.9, SANE 90 ± 12.5, pre-injury Tegner 6.7 ± 1.5, current Tegner 6.2 ± 1.5, and subjective IKDC 90 ± 10.9. Failures rates were 7.4% with and 13.8% without internal bracing (P = 0.672). There were no statistically significant or clinically relevant differences in subjective outcomes.
Arthroscopic primary repair has resulted in good objective and subjective outcomes at 3.2-year follow-up in a carefully selected population. The role of additional internal bracing is possibly beneficial, but larger groups are needed to assess this.
Level of evidence
KeywordsKnee Anterior cruciate ligament Primary repair Primary ACL repair Proximal ACL tear
Anterior cruciate ligament
International Knee Documentation Committee
Single Assessment Numeric Evaluation
No funding has been received for this study.
Compliance with ethical standards
Conflict of interest
Gregory S. DiFelice is a paid consultant for Arthrex and receives research funding from Arthrex, and Jelle P. van der List is a paid consultant for Arthrex. Anne Jonkergouw declares no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 16.Hennings J (2018) Primary anatomical repair of proximal ACL ruptures with suture anchors: 1 year follow-up. In: Annual Meeting of the DKG, GermanyGoogle Scholar
- 19.Hoffmann C, Friederichs J, von Ruden C, Schaller C, Buhren V, Moessmer C (2017) Primary single suture anchor re-fixation of anterior cruciate ligament proximal avulsion tears leads to good functional mid-term results: a preliminary study in 12 patients. J Orthop Surg Res 12:171CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Noyes FR, Barber SD, Mooar LA (1989) A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res 246:238–249Google Scholar
- 37.Shelbourne KD, Barnes AF, Gray T (2012) Correlation of a single assessment numeric evaluation (SANE) rating with modified Cincinnati knee rating system and IKDC subjective total scores for patients after ACL reconstruction or knee arthroscopy. Am J Sports Med 40:2487–2491CrossRefPubMedGoogle Scholar
- 41.Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar