Benedict U Nwachukwu1, Bhavik H Patel2, Yining Lu2, Answorth A Allen3, Riley J Williams3. 1. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: Nwachukwub@hss.edu. 2. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A. 3. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.
Abstract
PURPOSE: To critically review recent literature on outcomes following primary surgical repair of the anterior cruciate ligament (ACL). METHODS: In December 2018, a search of the MEDLINE database was conducted for English language articles reporting clinical outcomes of ACL repair from 2003 to 2018. Included studies were evaluated for patient demographics, patient-reported outcome measures, return to sports/work, patient satisfaction, and postoperative complications. Subgroup analysis was conducted for studies that included patients with only type 1/proximal ACL ruptures. RESULTS: Twenty-eight studies satisfied the inclusion criteria, comprising 2,401 patients (52.3% male, 35.7% female, 12.0% unspecified gender) with mean age ranging from 6.0 to 43.3 years. Most studies were conducted in Europe (82.1%), were level of evidence IV (60.7%), and were designed as case series (57.1%). Fourteen investigations (50.0%) used primary suture repair and 14 (50.0%) used dynamic intraligamentary stabilization. Preoperative ranges for Lysholm, International Knee Documentation Committee Score subjective, and Tegner scores were 28 to 100, 94.1 to 100, and 2 to 9, respectively. Postoperative ranges for the same measures were 80 to 100, 54.3 to 98, and 3.67 to 7, respectively. Time to return to sport/work ranged from 3.1 ± 3.3 to 17.4 ± 1.5 weeks. Frequency of rerupture, revision ACL surgery, and overall reoperations were as high as 23.1%, 33.3%, and 51.5%, respectively. Overall ACL repair survivorship ranged from 60.0% to 100.0%. In subgroup analysis for proximal ruptures treated with repair, the rates of revision ACL reconstruction (ACLR) and total reoperations were as high as 12.9% and 18.2%, respectively. CONCLUSIONS: Based on our cumulative findings across 2,401 patients from the 28 included studies, it appears that ACLR results in better survivorship and patient-perceived postoperative improvement when compared with ACL repair. At present, ACLR appears to remain the superior treatment strategy in the vast majority of cases. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.
PURPOSE: To critically review recent literature on outcomes following primary surgical repair of the anterior cruciate ligament (ACL). METHODS: In December 2018, a search of the MEDLINE database was conducted for English language articles reporting clinical outcomes of ACL repair from 2003 to 2018. Included studies were evaluated for patient demographics, patient-reported outcome measures, return to sports/work, patient satisfaction, and postoperative complications. Subgroup analysis was conducted for studies that included patients with only type 1/proximal ACL ruptures. RESULTS: Twenty-eight studies satisfied the inclusion criteria, comprising 2,401 patients (52.3% male, 35.7% female, 12.0% unspecified gender) with mean age ranging from 6.0 to 43.3 years. Most studies were conducted in Europe (82.1%), were level of evidence IV (60.7%), and were designed as case series (57.1%). Fourteen investigations (50.0%) used primary suture repair and 14 (50.0%) used dynamic intraligamentary stabilization. Preoperative ranges for Lysholm, International Knee Documentation Committee Score subjective, and Tegner scores were 28 to 100, 94.1 to 100, and 2 to 9, respectively. Postoperative ranges for the same measures were 80 to 100, 54.3 to 98, and 3.67 to 7, respectively. Time to return to sport/work ranged from 3.1 ± 3.3 to 17.4 ± 1.5 weeks. Frequency of rerupture, revision ACL surgery, and overall reoperations were as high as 23.1%, 33.3%, and 51.5%, respectively. Overall ACL repair survivorship ranged from 60.0% to 100.0%. In subgroup analysis for proximal ruptures treated with repair, the rates of revision ACL reconstruction (ACLR) and total reoperations were as high as 12.9% and 18.2%, respectively. CONCLUSIONS: Based on our cumulative findings across 2,401 patients from the 28 included studies, it appears that ACLR results in better survivorship and patient-perceived postoperative improvement when compared with ACL repair. At present, ACLR appears to remain the superior treatment strategy in the vast majority of cases. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.
Authors: Volker Musahl; Ian D Engler; Ehab M Nazzal; Jonathan F Dalton; Gian Andrea Lucidi; Jonathan D Hughes; Stefano Zaffagnini; Francesco Della Villa; James J Irrgang; Freddie H Fu; Jon Karlsson Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-12-05 Impact factor: 4.342
Authors: José F Vega; Gregory J Strnad; Isaac Briskin; Charles L Cox; Lutul D Farrow; Paul Fadale; David Flanigan; Michael Hulstyn; Peter B Imrey; Christopher C Kaeding; Brett D Owens; Paul Saluan; Rick Wright; Yi-Meng Yen; Kurt P Spindler Journal: Orthop J Sports Med Date: 2020-12-03
Authors: Roy A G Hoogeslag; Margje B Buitenhuis; Reinoud W Brouwer; Rosalie P H Derks; Sjoerd M van Raak; Rianne Huis In 't Veld Journal: Orthop J Sports Med Date: 2021-03-29