ACL repair vs. ACL reconstruction – repair has an upper hand

Researchers have voiced their support in favour of ACL repair (Anterior cruciate ligament repair) in the ACL repair vs. ACL reconstruction debate with findings of a new study indicating that the repair have better outcomes than those who have ACL reconstruction.

ACL reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. An ACL repair is a minimally invasive procedure to reattach the torn ligament. Currently, there is a scarcity of data directly comparing the effectiveness of ACL reconstruction with ACL repair.

Scientists compared 75 matched patients (based on variables including age, gender, BMI, the time between injury and surgery, knee laxity parameters, the presence of meniscal lesions, pre-operative activity level, and sports participation) who underwent ACL repair to those who underwent ACL reconstruction during the same period. Isokinetic testing was used to evaluate strength deficits compared to the contralateral limb at 6 months postoperatively. At the final follow-up, knee laxity parameters, return to sport, and outcome measures including Lysholm, Tegner, IKDC, ACL-RSI and the Forgotten Joint Score-12 (FJS) were recorded.

The ACL repair group had significantly better mean hamstring muscle strength (+1.7% +- 12.8, compared to contralateral limb) when compared to their counterparts who underwent ACL reconstruction (-10.0% +- 12.8, compared to contralateral limb) (p<0.0001). At a mean final follow-up of 30 +- 4.8 months, the ACL repair group had significantly better FJS (82.0 +- 15.1) compared to the reconstruction group (74.2 +- 21.7) (p=0.017).

No significant differences were demonstrated between groups concerning Lysholm, Tegner, and ACL-RSI scores. Non-inferiority criteria were met for the ACL repair group when compared to ACL reconstruction concerning subjective IKDC scores and knee laxity parameters (side-to-side anteroposterior laxity difference and pivot shift). There were no significant differences in the rate of return to the pre-injury level of the sport (repair group 74.7% vs reconstruction group 60%, p=0.078).

However, a significant difference was observed regarding the occurrence of ACL re-rupture (failure rates: ACL repair, 5,3%; ACL reconstruction, 0%; p=0.045). Patients experiencing failure of ACL repair were significantly younger than those that did not (26.8 years vs 40.7 years, p=0.013). There was no significant difference in rupture rates between groups when only patients aged over 22 years were considered (age >22, failure rates: ACL repair 2.8%; ACL reconstruction 0%, p=0.157).

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