Arthroscopic Primary Repair of the Anterior Cruciate Ligament: A Literature Review

Introduction: Anterior cruciate ligament (ACL) is an important mechanical stabilizer of the knee joint and ACL injuries are commonly seen among athletes. The gold-standard treatment adopted worldwide for ACL injuries is arthroscopic ACL reconstruction. However, arthroscopic primary ACL repair has gained popularity recently. The aim of this review is to provide an overall update of the studies that looked at arthroscopic primary ACL repair. Methods: Electronic databases were searched for relevant studies linked to arthroscopic primary ACL repair. We excluded any nonsurgical treatment studies, cadaveric studies and review articles. Nine hundred ninety-five articles were identified for screening, and a total of 523 patients from 8 articles were included for the review. Results: The study included articles published between 1985 and 2019: 66.6% were male, median age was 27 years; and 97.7% had sport related injuries. Two-hundred and nineteen patients had acute arthroscopic primary repair with varying types of ACL fixation; 287 of them had concomitant injuries. Rehabilitation program varies from a study to another; average evaluation for return to sport was 6 months. Eleven cases of the primary ACL repair have failed. Overall, patients reported satisfactory to good results. Conclusion: Arthroscopic primary ACL repair is a promising procedure with advantages over ACL reconstruction. However, appropriate patients’ selection, surgical expertise and instrumentations, pre- and post-op rehabilitation programs are all contributing factors to successful outcomes.