ACL Repair: Is it the future? Presentation by Gregory S. DiFelice

Background: Primary ACL repair, once regarded as a thing of the past, is beginning to make headway again. Currently, the primary way to restore the ACL after injury is to reconstruct it rather than repair it.  Reconstructing the ligament involves using another part of the body called a “graft” to replace the native ACL.  The most common grafts are taken from the patella ligament, the hamstring tendon, or from a cadaver.  Repair of the ACL was initially disregarded as a viable treatment because of poor outcomes.  In other words, we believed repairs were ineffective in restoring knee stability.  However, closer examination of the data revealed certain ACL tears did really well with repair, while others not so well (Dr. DiFelice covers this in the presentation).  ACL tears occurring proximal (think closer to the top of the knee) do well with repair: “ACL repair may be a viable option in young patients with acute, proximal ACL tears”(Van Eck, Limpisvasti, & ElAttrache, 2017).  ACL repair has purported benefits over reconstruction such as reduced recovery time, increased knee stability, and in the case of failure, the revision is much easier. For more information see below and make sure to check out Dr. DiFelice’s presentation:

Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament? A Systematic Literature Review.

Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: A systematic review of historical studies.

Some repairs require the addition of an “internal brace”, which makes the native ligament even stronger.  The internal brace is a new surgical device, is also being explored in primary UCL repair (think tommy john) in baseball players.  For more on the internal brace check out arthrex’s website here:

 https://www.arthrex.com/resources/video/7VkTovHtMUK7PwFUDGE2Lw/ulnar-collateral-ligament-repair-using-internalbrace-ligament-augmentation

Van der List, J. P., & DiFelice, G. S. (2017). Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: A systematic review of historical studies. The Knee, 24(5), 898-908. doi:10.1016/j.knee.2017.05.009

Van Eck, C. F., Limpisvasti, O., & ElAttrache, N. S. (2017). Is There a Role for Internal Bracing and Repair of the Anterior Cruciate Ligament? A Systematic Literature Review. The American Journal of Sports Medicine, 036354651771795. doi:10.1177/0363546517717956