Rupture of the anterior cruciateligament (ACL) occurs in more than 200.000 active adolescents and adults in theUnited States every year. While some patients can be treated without surgery,ACL reconstructive surgery is typically recommended for active individuals toallow for joint stabilization and to reduce long-term risk for meniscal tearsand osteoarthritis. Standard ACLreconstruction techniques use a tendon harvested from a different site in thebody and are often associated with morbidity from graft harvest, and extendedperiods time to full recovery and return to sports activity.
Traditionally, the concept of ACL repairwas felt to be insufficient due to limited healing potential of the ACL foundin studies in the 1990s. However, recent scientific analysis reveals thatcertain subgroups, especially tears directly from the femur bone can besuccessfully repaired with very encouraging clinical outcomes. Based onadvances in diagnostic imaging pre-operatively identification of tears that areamenable to repair, as well as development of modern arthroscopic surgicaltechnology and postoperative rehabilitation, primary repair of the ACL is currentlyemerging as an attractive alternative treatment option for eligible patientswith ACL tears of all ages and activity levels.
The technique of primary ACL repair hasseveral distinct clinical advantages compared to ACL reconstruction. Besides preservationof the complex anatomic attachments and dual bundle structure of the nativeACL, primary repair also preserves the nerve structures contained in the normalACL, thus retaining the normal biomechanical and proprioceptive function of theoriginal ACL which is otherwise lost with ACL reconstruction using a tendongraft. Most importantly, primary ACL repair can often be performed lessinvasively that ACL reconstruction and frequently allows for more proactive progressionof rehabilitation and faster return to athletic activity.