Primary repair vs arthroscopic reconstruction for proximal anterior cruciate ligament tears: a comparative study

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Abstract

Background. Anterior cruciate ligament (ACL) reconstruction is the gold standard surgical option for ACL tears. Another treatment method is primary ACL repair. The latter has some limitations such as a small range of indications — proximal tears only. However, they still constitute a significant portion of ACL injuries. Although the primary repair has been known for a long time and is still developing, recent publications show conflicting opinions regarding its application.

The aim of study is to compare functional outcomes of patients who underwent anterior cruciate ligament reconstruction and primary repair.

Methods. In the period from 2020 to 2023, we conducted randomized prospective multicenter control comparative study, which enrolled 170 patients with the ACL tear types A, B, E according to the Gächter classification. The injuries were no older than 3 months. The patients were divided into two groups: Group 1 — primary repair of the ACL, Group 2 — standard technique of the ACL reconstruction with a tendon autograft. Knee function was assessed before surgery and 3, 6, 12, 24 months postoperatively using the IKDC 2000 and Lysholm Knee Score.

Results. Type E of ACL injury prevailed in the sample. The most common associated injury in both cohorts was medial meniscus tear — 39.3±0.05% and 45.3±0.05% for Group1 and 2, relatively. Chondrolabral defects were observed in 15.5±0.04% of patients with primary repair, and in 10.5±0.03% of patients from the reconstruction group. Pain relief therapy in the form of opioid analgesics received 46.03±0.06% patients in Group 2 and 25.35±0.05% in Group 1 (p<0.05). The proportion of patients requiring reoperation for ACL injury in Group 1 was 3.5% and 1.2% in Group 2 (p>0,05). Both groups had a statistically significant increase in functional outcomes according to the scales at 3, 6, 12 months (p<0.05). The difference in knee function between the groups was not statistically significant (p>0.05).

Conclusion. Primary ACL repair still retains a large number of limitations. It cannot and should not replace ACL reconstruction. However, with strict adherence to the indications and surgical technique, primary ACL repair demonstrates comparable functional outcomes.

About the authors

Sergey A. Gerasimov

Privolzhsky Research Medical University; “Orthopaedic Research Projects”

Email: gerasimoff@list.ru
ORCID iD: 0000-0002-3179-9770

Cand. Sci. (Med.)

Россия, Nizhny Novgorod; Nizhny Novgorod

Ekaterina A. Morozova

Privolzhsky Research Medical University; “Orthopaedic Research Projects”

Author for correspondence.
Email: ekaterina.m.96@mail.ru
ORCID iD: 0000-0001-7548-9398
Россия, Nizhny Novgorod; Nizhny Novgorod

Daria A. Naida

Main Military Clinical Hospital named after academician N.N. Burdenko; “Orthopaedic Research Projects”

Email: dariaanayda@gmail.com
ORCID iD: 0000-0003-4567-2612

Cand. Sci. (Med.)

Россия, Moscow; Nizhny Novgorod

Denis O. Kolmakov

Central Clinical Hospital “RZD-Medicine”; “Orthopaedic Research Projects”

Email: doctor.kolmakov@mail.ru
ORCID iD: 0009-0005-6669-0838
Россия, Moscow; Nizhny Novgorod

Andrey A. Zykin

Privolzhsky Research Medical University

Email: dr.zykin@mail.ru
ORCID iD: 0000-0002-6321-3631

Cand. Sci. (Med.)

Россия, Nizhny Novgorod

Ekaterina V. Khramtsova

Privolzhsky Research Medical University

Email: e.v.khramtsova@bk.ru
ORCID iD: 0000-0003-1737-1214
Россия, Nizhny Novgorod

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