Arthroscopic ACL Primary Repair: Indications, Techniques and Outcomes (AANA19)-Instructional Course Lecture_ Arthroscopic ACL Primary Repair_ Indications, Techniques and Outcomes-Dr. Gregory S. DiFelice, M.D.

Instructional Course Lecture_ Arthroscopic ACL Primary Repair_ Indications, Techniques and Outcomes-Dr. Gregory S. DiFelice, M.D.

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Video Transcription

Video Summary

This presentation from Hospital for Special Surgery revisits anterior cruciate ligament (ACL) primary repair, a once-abandoned technique now gaining renewed interest due to advances in arthroscopy and patient selection. Historically, ACL repair showed about 50% success, often performed open with poor outcomes and rehabilitation, leading to its abandonment in favor of reconstruction. The speaker, Dr. Greg, advocates selective arthroscopic repair of proximal ACL tears without scaffolds, emphasizing repair as a simpler, less invasive option that preserves native tissue and proprioception. Over 10 years, he has developed a suture-anchor technique akin to rotator cuff repair, sometimes augmented with internal bracing, achieving about 90% clinical success in 250 cases with some late failures, especially in teenagers. MRI studies reveal 43% of ACL tears are proximally located and potentially repairable. Repair patients tend to have faster recovery, less pain, and fewer complications than reconstructions. Biomechanical studies show repaired ligaments closely mimic native ACL strength. Although some reports show higher failure in adolescents, this approach offers an alternative to reconstruction with easier revisions if needed. Other groups worldwide are exploring similar techniques, indicating growing interest. The presentation concludes that primary ACL repair is a viable option for selected patients, warranting further research and discussion to optimize indications and outcomes.

Asset Caption

Instructional Course Lecture: Arthroscopic ACL Primary Repair: Indications, Techniques and Outcomes.

Keywords

Anterior Cruciate Ligament

ACL primary repair

arthroscopic repair

suture-anchor technique

proximal ACL tears

internal bracing

ACL reconstruction alternatives