AJSM - 2026-08-03 - Journal Article
Primary ACL Repair and Reconstruction in Isolated ACL Ruptures: Forgotten Joint Scores and the Association Between Residual Laxity and Joint Awareness.
Altun O, Ergişi Y, Altıntaş M, Özdemir E, Daşar U, Bozkurt M
Topics
Key Takeaway
Primary ACL repair yielded significantly higher Forgotten Joint Score-12 values than hamstring autograft reconstruction (87.0 vs 77.5; mean difference 9.5 points, Cohen d=0.66) despite equivalent Lysholm, IKDC, Tegner, laxity, and return-to-sport outcomes.
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Summary
This retrospective cohort compared primary ACL repair versus hamstring autograft reconstruction in carefully selected proximal ACL tears, using the FJS-12 as the primary patient-reported joint awareness outcome alongside conventional metrics. No between-group differences were detected in Lysholm, IKDC, Tegner, postoperative Lachman or pivot-shift laxity, or rerupture rates. The repair group reported significantly higher FJS-12 scores (87.0 vs 77.5; P=.006), and multivariable regression identified residual postoperative laxity as independently associated with lower FJS-12 values in both Lachman- and pivot-shift-based models (R²=0.649 and 0.680, respectively).
Key Limitation
Retrospective non-randomized design with surgeon-directed patient selection for repair versus reconstruction introduces substantial confounding that cannot be fully corrected by multivariable regression.
Original Abstract
BACKGROUND
Primary anterior cruciate ligament (ACL) repair has recently reemerged as a treatment option for carefully selected proximal ACL tears. However, evidence regarding patient-reported joint awareness and the relationship between postoperative laxity and joint awareness remains limited.
PURPOSE
To compare joint awareness, clinical outcomes, and postoperative laxity between primary ACL repair and hamstring tendon autograft reconstruction in carefully selected patients with isolated ACL rupture, and to explore the association between residual laxity and postoperative joint awareness.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
This retrospective cohort study included 85 patients with isolated ACL rupture treated with either primary ACL repair (n = 26) or hamstring autograft reconstruction (n = 59), with a minimum follow-up of 24 months. Clinical outcomes, including visual analog scale score, Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner activity scale score, postoperative knee laxity, return to sport, and rerupture rates, were evaluated. The authors also used the Forgotten Joint Score-12 (FJS-12), a measure of joint awareness, to evaluate patients. A higher score reflects lower joint awareness, suggesting function more similar to a native knee. Multivariable regression analyses were performed to evaluate variables associated with postoperative FJS-12 values.
RESULTS
No differences were observed between groups in postoperative Lysholm, IKDC, and Tegner activity scale scores; Lachman- and pivot-shift-assessed postoperative laxity; and return-to-sport rates. However, postoperative FJS-12 values were significantly higher in the repair group compared with the reconstruction group (87.0 ± 15.0 vs 77.5 ± 14.2; mean difference, 9.5 points [95% CI, 2.8-16.3]; P = .006), corresponding to a moderate effect size (Cohen d = 0.66). Secondary exploratory regression analyses demonstrated that residual postoperative laxity was associated with lower postoperative FJS-12 values in both Lachman- and pivot-shift-based models ( R 2 = 0.649 and 0.680, respectively; P < .001 for both).
CONCLUSION
In carefully selected patients with proximal ACL tears and adequate tissue quality, no significant between-group differences were detected in conventional clinical outcomes, postoperative laxity, return-to-sport rates, or rerupture rates between primary ACL repair and reconstruction. Primary ACL repair was associated with higher postoperative FJS-12 values at short- to midterm follow-up, suggesting function more similar to that of a native knee. Residual postoperative laxity was associated with lower FJS-12 values in secondary exploratory analyses.