ACL repair associated with better clinical and functional outcomes than ACL reconstruction

A comparison of matched patient cases involving ACL repair with ACL reconstruction found that patients who undergo ACL repair have better outcomes than those who have ACL reconstruction, according to research presented today at the American Orthopaedic Society of Sports Medicine 2022 Annual Meeting.

Anterior cruciate ligament 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.

Adnan Saithna, MD, from FRCS, AZBSC Orthopedic, Phoenix, and colleagues designed a retrospective analysis to compare the clinical and functional outcomes of ACL repair with ACL reconstruction, at a minimum follow-up of two years.

Dr. Saithna compared 75 matched (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.

According to Dr. Saithna's analysis, 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)

ACL repair was associated with significantly better isokinetic strength tests at 6 months, better FJS at final follow-up, and non-inferior IKDC, Lysholm, Tegner, ACL-RSI, and knee laxity parameters. However, the rate of re-rupture was significantly higher when compared to ACL reconstruction and younger patients were particularly at risk."

Adnan Saithna, MD, from FRCS, AZBSC Orthopedic, Phoenix