STRONG RECOMMENDATION Two high quality studies (Sporsheim 2019, Drogset 2006) and one low quality study (Achtnich 2016) show a lower rate of revision ACL surgery in patients undergoing primary reconstruction than in those undergoing repair. Regarding post-operative function, two high quality studies favor reconstruction (Drogset 2006, Kosters 2020) while two high quality studies favor repair (Sporsheim 2019, Murray 2020).
Benefits/Harms of Implementation
ACL reconstruction is a common procedure and high quality studies suggest a lower rate of revision surgery compared to repair.
Outcome Importance
Given the increasing incidence of ACL injury and the potential medical, financial, and psychosocial impact of revision surgery, evaluation of factors affecting the risk of re-operation is important.
Cost Effectiveness/Resource Utilization
Both ACL reconstruction and repair are resource-intensive when accounting for surgical costs as well as post-operative rehabilitation. Revision surgery, when necessary, also requires substantial resources.
Acceptability
While ACL repair research and technique continue to develop, ACL reconstruction is currently the standard of care.
Feasibility
ACL reconstruction is currently the standard of care for primary ACL injury.
Future Research
Future research should focus on lowering the rate of revision surgery for ACL repair. This may include innovations in patient selection based on tear location, biologic intervention and/or surgical technique.
- Achtnich, A., Herbst, E., Forkel, P., Metzlaff, S., Sprenker, F., Imhoff, A. B., Petersen, W. Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction. Arthroscopy 2016; 12: 2562-2569
- Drogset, J. O., Grontvedt, T., Robak, O. R., Molster, A., Viset, A. T., Engebretsen, L. A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament. Journal of Bone & Joint Surgery - American Volume 2006; 5: 944-52
- Kosters, C., Glasbrenner, J., Spickermann, L., Kittl, C., Domnick, C., Herbort, M., Raschke, M. J., Schliemann, B. Repair With Dynamic Intraligamentary Stabilization Versus Primary Reconstruction of Acute Anterior Cruciate Ligament Tears: 2-Year Results From a Prospective Randomized Study. American Journal of Sports Medicine 2020; 5: 1108-1116
- Murray, J. J., Renier, C. M., Ahern, J. J., Elliott, B. A. Neuromuscular Training Availability and Efficacy in Preventing Anterior Cruciate Ligament Injury in High School Sports: A Retrospective Cohort Study. Clinical Journal of Sport Medicine 2017; 6: 524-529
- Sporsheim, A. N., Gifstad, T., Lundemo, T. O., Engebretsen, L., Strand, T., Molster, A., Drogset, J. O. Autologous BPTB ACL Reconstruction Results in Lower Failure Rates Than ACL Repair with and without Synthetic Augmentation at 30 Years of Follow-up: A Prospective Randomized Study. Journal of Bone & Joint Surgery American 2019; 0: 20