A Novel Arthroscopic Technique for ACL Preservation

Gregory S. DiFelice, MD


March 04, 2016

Reconstruction Remains an Option

To our knowledge, the results of this study represent the first human case series of an arthroscopic method of primary ACL repair. The study focuses on the historical cohort of patients that seems to have had better results with open-repair methods—that is, those patients with proximal tears with excellent tissue quality. However, the arthroscopic method used harnesses the advances made over the past 25 years to maximize patient outcomes.

Diagnostically, we are able to preoperatively identify patients who have a higher likelihood of successful repair using MRI. With the breathtaking advances in arthroscopic and suture-anchor technology, and with limited morbidity, we now have the technical ability to apply a minimally invasive technique to firmly reapproximate the torn tissues back to their boney origin while maintaining most of the native ACL biology.

Finally, rehabilitatively, early motion is pursued to maximize range of motion and function of the knee while minimizing stiffness and atrophy.

While this study reports the results in the first 11 patients in which this new methodology was used, I have performed this technique on over 50 patients to date, with continued success. The only failures noted—with the exception of the aforementioned patient who experienced a pop and increased laxity—have been reinjuries that occurred during sporting activities well over 1 year postoperatively.

Several of these reinjured patients underwent uncomplicated "revision" surgery that was essentially a primary reconstruction. This illustrates one of the significant benefits of using the ACL repair approach for proximal tears: If the repair fails and the patient has recurrent instability, no bridges have been burned and a reconstruction can be performed with little difficulty.

A New Chapter in ACL Surgery

With this recent publication of a successful series of ACL primary repairs performed arthroscopically in patients with proximal tears, a new chapter of ACL surgery will hopefully blossom. Rather than sticking with our current one-size-fits-all approach of reconstructing every patient with a torn ACL who wishes to remain active, we should be pursuing a more biologic and individually tailored surgical approach that is based on the injury pattern to the native tissues, has significantly lower morbidity, and focuses on ACL preservation.


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