- •Allows the “best of both worlds” by incorporating all the potential advantages of ACL repair with gold-standard ACL reconstruction, whilst avoiding most problems of either approach.
- •This procedure can be performed in the subacute phase, and hence allows a trial of non-operative treatment to identify patients who do not warrant surgery: either those that heal naturally, or those capable of “coping” with ACL deficiency.
Advantages and Disadvantages
- •A ‘time-tested’ ACL reconstruction which predictably restores knee stability is performed, and the risk of failure of ACL repair due to non-healing is avoided.
- •This technique restores the complex native ACL anatomy, especially the fan-shaped morphology of the tibial insertion which is impossible to replicate with available reconstruction techniques using cylindrical or flat grafts.
- •Potentially restores normal rotational knee kinematics, and in the long-term may avoid the risk of osteoarthritis associated with reconstructed ACLs.
- •Preservation of neural receptors within the remnant which possibly ensure early return of proprioception and a more normal feeling of the knee.
- •Unlike ACL repair, this procedure is performed in the subacute phase following an ACL tear, and decreases the risk of postoperative arthrofibrosis noted with surgical procedures performed in the acute phase.
- •Since narrow sockets of 7.0-8.0 mm are created, revision surgery is expected to be similar to primary reconstruction.
- •As compared to ACL repair, autograft harvest and its associated morbidity is not avoided.
- •Biological healing of the remnant ACL native tissue is critical for the potential advantages of anatomical and neuromotor restoration to occur. The healing interfaces include remnant to femoral insertion site, and between autograft and remnant. In the absence of biological healing and incorporation, there is a risk of this technique being equivalent to a narrow graft ACL reconstruction.
- •There is a risk of overstuffing the notch and resultant ACL impingement in extension, hence the autograft diameter should not exceed 8.00 mm.
- •With unstable Sherman Type II avulsions that are sutured to the biological internal brace at the femoral insertion, if healing of remnant to autograft does not occur, there is a risk of cyclops formation and impingement.
Outline of the clinical problem
- Vermeijden H.D.
- van der List J.P.
- O’Brien R.
- DiFelice G.S.
- Heusdens C.H.W.
- Hoogeslag R.A.G.
- Brouwer R.W.
- de Vries A.J.
- Boer B.C.
- Huis In‘t Veld R.
Surgical indications and contraindications
- Zhang S.
- Matsumoto T.
- Uefuji A.
- Matsushita T.
- Takayama K.
- Araki D.
- Nakano N.
- Nagai K.
- Matsuzaki T.
- Kuroda R.
- Kurosaka M.
Conclusions and future perspective
Financial grants received for this study
Financial renumeration/biases for any author
Declaration of interests
- Current status and potential for primary ACL repair.Clin Sports Med. 2009; 28: 51-61
- High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes.Ann Rheum Dis. 2004; 63: 269-273
- Patients forget about their operated knee more following arthroscopic primary repair of the anterior cruciate ligament than following reconstruction.Arthroscopy. 2020; 36: 797-804https://doi.org/10.1016/j.arthro.2019.09.041
- ACL repair: a game changer or will history repeat itself? A critical appraisal.J Clin Med. 2021; 10: 912https://doi.org/10.3390/jcm10050912
- Efficacy of nonaugmented, static augmented, and dynamic augmented suture repair of the ruptured anterior cruciate ligament: a systematic review of the literature.Am J Sports Med. 2020; 48: 3626-3637https://doi.org/10.1177/0363546520904690
- Delay of 2 or 6 weeks adversely affects the functional outcome of augmented primary repair of the porcine anterior cruciate ligament.Am J Sports Med. 2010; 38: 2528-2534https://doi.org/10.1177/0363546510377416
- The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation.Am J Sports Med. 1991; 19: 243-255https://doi.org/10.1177/036354659101900307
- Effect of remnant tissue preservation on tendon graft in anterior cruciate ligament reconstruction: A biomechanical and histological study.Am J Sports Med. 2016; 44: 1708-1716
- ACL reconstruction preserving the ACL remnant achieves good clinical outcomes and can reduce subsequent graft re-ruptures.Orthop J Sports Med. 2013; 12325967113505076
- Anterior cruciate ligament remnant tissue harvested within 3 months after injury predicts higher healing potential.BMC Musculoskeletal Disorders. 2015; 16: 390https://doi.org/10.1186/s12891-015-0855-0
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