Summary

ACL repair at a minimum follow-up of 2 years shows good clinical outcomes in carefully selected patients with a proximal tear

Abstract

Purpose

Recently, there has been renewed interest in anterior cruciate ligament (ACL) repair. The purpose of this study was to evaluate the results of ACL repair at a minimum follow-up of 2 years.

Methods

A retrospective analysis of all patients who underwent ACL repair between January 2019 and May 2022 was performed. Inclusion criteria were a proximal tear (type 1 or 2 according to Sherman’s classification), 2 years of minimum follow-up, and the absence of other concomitant injuries. Patients who were at high risk and had rotatory instability (jerk test ++/+++) underwent a combined anterolateral procedure with different techniques such as suture, Internal Brace fixation or modified tenodesis according to Coker-Arnold. Patient reported outcomes measures (PROMs) such as International Knee Documentation Committee (IKDC), Forgotten Joint Score (FJS-12), Return to sport after injury scale (ACL-RSI), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner's activity scale and KT-1000 arthrometer assessment were performed.

Results

A total of 119 patients were included in the study. 3 patients were lost to follow-up. There were 68 males and 48 females with a mean age of 31.9 years old. The failure rate was 10.3% (12 out of 116). None of the failed patients was older than 29 years. Of these, 17 (15%) were treated with a modified Coker-Arnold tenodesis, 7 (6%) with an anterolateral ligament repair with Internal Brace, 8 (7%) with a Segond fracture fixation, and 69 (59%) with a suture. A total of 93 patients (89.4%) returned to sports and of these 82 (88.1%) to the same pre-injury level according to the Tegner scale. The mean IKDC was 82.6 among those who did not return to sports activity, compared with 74.51 in those who returned to it. The mean KOOS sport was 77.48 among those who returned to sports activity and 60.85 among those who did not. The FJS-12 and ACL-RSI also showed differences between patients who returned to sports activity and those who did not, 80.2 vs 63.06 for the FJS-12 and 70.44 vs 57.03 for the ACL-RSI, respectively. About the activity level measured on the Tegner scale, the failed patients had a mean score of 8.33 (range 6-9) while the others had a mean score of 5.78 (range 3-9). 14 patients underwent reoperations for reasons other than failure: 8 had contra-lateral injuries, 2 had arthrofibrosis and 4 had secondary meniscal lesions.

Conclusions

ACL repair at a minimum follow-up of 2 years shows good clinical outcomes in carefully selected patients with a proximal tear and an age greater than or equal to 30 years.