Arthroscopy - 2026-05-15 - Journal Article
Primary Anterior Cruciate Ligament Repair for Acute Proximal Tears Shows High Return to Sport and a 10% Failure Rate at a Minimum 2-Year Follow-Up.
Carrozzo A, Annibaldi A, Pucciatti R, Nasso V, Ciccarelli G, Cardarelli S, Orlandi P, Ferretti A, Monaco E
Topics
Key Takeaway
Arthroscopic primary ACL repair in acute proximal tears (Sherman I-II) achieved 95.4% RTS and a 10% failure rate at mean 47.9 months, with failure concentrated in patients younger than 25 years.
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Summary
This retrospective case series evaluated arthroscopic primary ACL repair in 120 consecutive patients with acute proximal tears (Sherman I-II) repaired within 15 days of injury, with lateral extra-articular augmentation in 106 of those patients. Overall failure rate was 10% (8.5% in the augmented subgroup), and 95.4% of non-failure patients achieved RTS, with 79.6% returning to preinjury Tegner level or higher. Failure was significantly associated with younger age (mean 22.3 vs. 32.9 years) and higher activity level; mean side-to-side laxity was 1.6 mm.
Key Limitation
Absence of a concurrent ACL reconstruction control group makes it impossible to determine whether the 10% failure rate and RTS outcomes are superior, inferior, or equivalent to the current standard of care.
Original Abstract
PURPOSE
To evaluate the clinical outcomes after arthroscopic primary anterior cruciate ligament (ACL) repair, with and without lateral extra-articular procedures, at a minimum of 2 years follow-up.
METHODS
A retrospective case series of prospectively collected data was conducted on patients operated between 2018 and 2023. Consecutive patients with acute proximal ACL tears underwent arthroscopic primary repair within 15 days of injury when intraoperative reducibility and good tissue quality (Sherman I-II) were confirmed. Patients with anterolateral lesions or high-risk received a concomitant lateral extra-articular procedure (anterolateral structure repair, Segond fixation, or Coker-Arnold tenodesis). Outcomes included International Knee Documentation Committee subjective score, Lysholm score, Knee injury and Osteoarthritis Outcome Score, ACL-return to sports after injury score, Forgotten Joint Score-12, Tegner, and side-to-side laxity; analyses assessed group comparisons and associations with failure and return to sport (RTS).
RESULTS
Of 123 patients receiving ACL primary repair, 120 completed the 24 months-minimum follow-up (mean 47.9 ± 12.8 months; range 25-82). The overall failure rate was 10%. Among the 106 patients treated with combined ACL primary repair and a lateral extra-articular procedure, 9 (8.5%) experienced failure. Patients who had ACL repair failure were significantly younger (mean age, 22.3 vs 32.9) and more active. RTS was achieved in 95.4% of patients excluding failures, with 79.6% returning to preinjury or higher Tegner activity scale levels. Successful RTS was associated with older age, lower side-to-side laxity, and higher ACL-return to sports after injury and Knee injury and Osteoarthritis Outcome-Sport scores. Regarding patient-reported outcome measures, 69.6% achieved patient-acceptable symptom state for International Knee Documentation Committee, 84.8% for ACL-return to sports after injury, and 69.6% for Forgotten Joint Score-12. The mean side-to-side laxity was 1.6 ± 1.2 mm. The secondary surgery rate (excluding failures) was 11.6%, with most involving contralateral ACL injuries.
CONCLUSIONS
Arthroscopic primary ACL repair led to high RTS rates, 10% failure rate, and satisfactory patient-reported outcome measures at a minimum 2-year follow-up. Outcomes were significantly influenced by age and activity level, with higher failure risk in younger and more active patients.
LEVEL OF EVIDENCE
Level IV, retrospective case series.