Arthroscopy - 2026-06-25 - Journal Article
Anterior Cruciate Ligament Repair Shows Higher Failure Rate but Similar Functional Outcomes Compared With Reconstruction at 5 Years in Matched-Pair Analysis.
Tambosco V, de Oliveira Neto VE, Mosca A, Poilvache H, Vieira TD, Barth J, Sonnery-Cottet B
Topics
Key Takeaway
ACL repair carries a 15.5% failure rate versus 4.2% for reconstruction at mean 6.3-year follow-up, with the excess risk concentrated in patients under 40 and those with preoperative pivot shift.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective propensity-matched study compared primary ACL repair versus reconstruction in 71 pairs matched for age, sex, BMI, time to surgery, activity level, and preoperative pivot shift at minimum 5-year follow-up. Repair failed at 15.5% versus 4.2% for reconstruction (P=.032), driven by patients under 40 (P=.037) and those with preoperative pivot shift (P=.025); patients over 40 and those without pivot shift showed no significant failure rate difference. Mean PROMs were equivalent between groups, though a higher proportion of repair patients achieved PASS for KOOS symptoms (67.7% vs. 47.0%, P=.033).
Key Limitation
The repair technique was not standardized or described in sufficient detail, making it impossible to determine whether failure differences reflect patient selection, surgical execution, or repair construct choice.
Original Abstract
PURPOSE
To compare the 5-year outcomes of anterior cruciate ligament (ACL) repair versus ACL reconstruction in a matched cohort.
METHODS
Patients who underwent primary ACL repair or reconstruction between 2017 and 2019 were retrospectively analyzed. All surgical procedures were performed by two senior surgeons using standardized techniques. Patients were propensity matched 1:1 for age, sex, body mass index, time from injury to surgery, activity level, and preoperative pivot shift. Complications, reoperations, and patient-reported outcome measures (PROMs) including International Knee Documentation Committee, Lysholm, Knee injury and Osteoarthritis Outcome Score, ACL-Return to Sport after Injury, and Forgotten Joint Score-12 were evaluated at a minimum of 5 years.
RESULTS
Seventy-one matched pairs (142 patients) were included, mean follow-up was 6.3 ± 1.1 years [0.5-7.6] in the repair group and 6.4 ± 0.5 years [5.7-7.4] in the reconstruction group. The failure rate was significantly higher in the repair group (15.5%) compared with the reconstruction group (4.2%) (P = .032). Subgroup analysis showed that this difference was primarily observed in patients younger than 40 years (P = .037) and in those presenting with a preoperative pivot shift (P = .025), whereas no difference was found in patients older than 40 years (P = .99) and without preoperative pivot shift (P = .68). A significantly higher proportion of patients in the repair group achieved the Patient Acceptable Symptom State for Knee injury and Osteoarthritis Outcome Score symptoms compared with reconstruction patients (67.7% vs. 47.0%, P = .033). No significant differences in mean patient-reported outcome measures were found between groups at final follow-up.
CONCLUSION
At midterm follow-up, ACL repair showed comparable functional outcomes but higher failure rates than reconstruction, particularly in younger or pivoting patients.
LEVEL OF EVIDENCE
Level III, retrospective matched comparative study.