ACL Repair: Modern-Day Techniques, Outcomes and Their Role in Today’s ACL Toolbox (2024 Annual Meeting)-ACL Repair: Modern-Day Techniques, Outcomes and Their Role in Today’s ACL Toolbox

Video Transcription

Video Summary

The video presents a comprehensive discussion on the evolution, techniques, and outcomes of Anterior Cruciate Ligament (ACL) repair as a selective, patient-tailored alternative to traditional ACL reconstruction. Experts including Sebastian Rueck, Dr. Sherman, Greg DeFelice, Wimmy Deweegee, and others highlight the resurgence of ACL repair due to improved understanding of tear types, tissue quality, and modern surgical methods.<br /><br />Historically, ACL repair was abandoned due to high failure rates, especially in young, active patients. Recent advances in arthroscopic techniques, suture augmentation, and biological scaffolding have shown promising results, particularly for proximal tears with good tissue quality. Studies reveal ACL repair can facilitate faster recovery, preserve native ligament proprioception, and reduce donor-site morbidity compared to reconstruction. However, younger patients under 21 exhibit higher failure rates, necessitating cautious patient selection and potentially adjunct procedures such as lateral extra-articular tenodesis to improve stability and outcomes.<br /><br />Various repair techniques discussed include dual suture anchor repair, internal bracing with collagen-based sutures, and the application of a bovine collagen scaffold implant to promote healing by stabilizing the clot and supporting ligament regeneration. Clinical outcomes indicate comparable knee stability and patient-reported outcomes between repair and reconstruction, with some evidence of superior early strength and quicker return to sport in repair groups. Still, the need for more high-quality, long-term studies and randomized controlled trials is emphasized.<br /><br />Timing of surgery remains flexible, with many advocating early intervention but acknowledging repairs can be successful even months after injury, particularly in older patients. The discussion underlines the importance of individualized treatment algorithms rather than a universal approach, balancing surgical innovation with realistic expectations and informed patient consent.

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Keywords

ACL repair

Anterior Cruciate Ligament

ACL reconstruction

arthroscopic techniques

suture augmentation

biological scaffolding

patient selection

lateral extra-articular tenodesis

dual suture anchor repair

internal bracing

bovine collagen scaffold