Editorial Commentary: Primary Repair of the Anterior Cruciate Ligament Shows Positive Midterm Outcomes When Properly Indicated

Abstract

Anatomic anterior cruciate ligament (ACL) reconstruction is the gold standard treatment for ACL injury and has been shown to restore the 3-dimensional joint laxity. Recently, however, there is renewed interest in primary repair of the injured ACL in selected cases. Research shows that, in some cases, short- and midterm outcomes of ACL repair are favorable, albeit with greater failure rates than ACL reconstruction. No long-term outcomes are yet available, which could address whether repair reduces risk of osteoarthritis relative to reconstruction with a graft. Historically, primary repair showed poor outcomes, but for proximal and acute injuries with good vascularity, innovations such as suture anchors, dynamic intraligamentary stabilization, and suture tape augmentation show promise, particularly in paediatric patients. The old orthopaedic dogma that “ACL cannot heal” is not entirely correct.