By: Dr. William Nordt III
The modern day ACL reconstruction (using substitute graft tissue) remains the gold standard to treat the ACL-injured knee.
However an old procedure known as an ACL repair is trying to make a come back!
ACL tears are often treated surgically in sports-minded individuals. An "ACL repair" is simply suturing the two torn ends together. This is a relatively easy arthroscopic operation and was the procedure of choice in the 1980's. In theory, this was a good idea, however, due to poor outcomes, this procedure was surpassed with the "ACL reconstruction." In a reconstruction, the torn ACL is remade with an alternative piece of tissue (the graft) which provides immediate strength and security to the knee.
The ACL repair has always been inferior to the ACL reconstruction in terms of predictably stabilizing the knee. It also requires a prolonged recovery period. So the ACL reconstruction remains the superior procedure.
New research is being done that re-examines the merits of repairing the ACL. Repairs can be done with internal bracing sutures to assist with early stability. In clinical studies, researchers are using special proteins and stem cells to see if repairs can work better than previously thought. In one study (the BEAR procedure) a sponge infused with growth factors is inserted that may help the ACL fibers to heal. All of this is a promising direction.
The ACL repair has promise but remains clinically unproven. (Beware of medical marketing that says otherwise). The long term outcomes of ACL repair procedures in the past were poor. The outcomes of newer ACL repair procedures are still unknown. In fact, we won't know the results until athletes have returned to sports with their ACL-repaired knee for several years. Children with open growth plates may be the best candidates for this procedure in the early going. The failure rate of this procedure is likely to be significant until more technologically advanced scaffolds are developed. At this time, the most predictable and successful ACL procedure is, by far, the ACL reconstruction.
A marketing video from the Children's Hospital in Boston:
An internal bracing procedure being performed:
Results of the Internal Bracing procedure; 60% of patients did not return for follow-up which is very poor: Did the procedure fail?
About the author:
Dr. William Nordt is an orthopedic surgeon in Richmond, VA and a partner in OrthoVirginia since 1990. Perennially voted one of Richmond’s “Top Docs,” he has a strong commitment to excellence in all aspects of orthopedic care, ensuring that every patient is treated with courtesy and compassion. He has served as the team physician for the U.S. Olympic ski team and Olympic training camp, as well as various professional soccer, football, and hockey teams.