I’m excited to be one of the first WA surgeons to research and perform ACL repair (rather than reconstruction).
Depending on the exact nature of your injury, it may mean you have three treatment options – conservative management, reconstruction or repair.
The history of ACL repair
If you’d busted your ACL in the 1980s, your surgeon would probably have recommended a primary ACL repair. As time went on, ACL repair was superseded by ACL reconstruction.
ACL repair never entirely died out though. We’ve continued to research it as surgical techniques advanced, leading to a resurgence of interest in ACL repair today.
Though I still recommend ACL reconstruction for most patients (especially those in high-energy sports), a carefully selected group of patients may benefit from a modern ACL repair.
What’s the goal of ACL surgery?
ACL surgery – whether repair or reconstruction – aims to ensure a stable knee joint so you can return to your normal activities and quality of life.
As always in surgery, there are both benefits and risks to consider when it comes to ACL surgery.
ACL reconstruction has many advantages (including predictable outcomes) but it involves risks too, such as:
- Failure of the graft
- Risks associated with using donor material
- Just not ‘feeling normal’.
ACL repair involves a different set of risks and benefits. It’s important to explore these with your surgeon to ensure you proceed with the best surgery for your particular needs.
What’s involved in a primary ACL repair?
Primary ACL repair aims to preserve and mend your own anterior cruciate ligament, rather than removing and replacing it (as in an ACL reconstruction).
Primary ACL repair is a minimally invasive procedure that involves reattaching the torn ACL to the bone.. This may be done using various types of anchors, tape or dynamic stabilisation techniques.
The advantages of a primary ACL repair are that it:
- Preserves your own tissue
- May help preserve proprioceptive function and feel more natural
- Avoids the risks associated with using donor material
- May promote early rehabilitation.
The risks include:
- Failure – the ACL may rupture again, at which point you may require an ACL reconstruction
- Durability – repair is rarely an option for athletes who place high demands on the knee for pivoting, tackling etc.
Who is a candidate for primary ACL repair?
Based on currently available evidence, ACL repair is only appropriate for a small, carefully selected group of patients with less severe ACL injuries.
You may be suitable for an ACL repair if you:
- Are older and not involved in high-energy sports
- Prefer a less invasive surgery with early rehabilitation so you can return to work more quickly
- Want a knee that feels as normal as possible
- Can accept the possibility of a second surgery if repair does not succeed.
I am quite cautious about who I select for ACL repair because I want your treatment to succeed. If I think you may benefit from ACL repair rather than reconstruction, I will talk you through the procedure to ensure you understand the potential risks as well as the benefits.
