For many years now, patients with an ACL injury requiring surgical repair have been given only one option: reconstruction. The underlying viewpoint was that the ACL has limited capacity to heal or recover so there was no point in attempting a primary repair.
Recent evidence challenges that assumption. Indeed it seems that – in the right sort of patient with the right sort of ACL tear and using the right surgical techniques – primary ACL repair may be beneficial.
How did we get here?
ACL repair was abandoned years ago because the technique used at that time (open surgery) had high failure and complication rates and surgeons rightly began to favour reconstruction instead.
Over the last decade, though, things have begun to change. We have developed new arthroscopic (keyhole) surgical techniques and new rehabilitation protocols. And we have also given careful thought to which patients are best suited to ACL repair based on considerations such as tear type and tissue quality.
To repair or to reconstruct?
So, now we have an evidence base to guide the choice of patients and modern surgical techniques to facilitate laparoscopic repair. When performed in these specific circumstances, the results from these modern ACL repair procedures are encouraging, demonstrating comparable outcomes to ACL reconstruction.
But ACL repair is not simply a different way to the same clinical outcome. It has further benefits for patients.
ACL reconstruction is still considered major surgery, involving tendon harvest and the placement of tissue grafts that take time to heal. In contrast, ACL repair involves far less of an insult to the knee. For patients, that means greater comfort, swifter recovery and a faster return to normal daily activities. These are significant patient-centred outcomes that should not be dismissed.
Which patients could be suitable for ACL repair?
As has always been the case, some ACL injuries require no surgery at all and others require full reconstruction.
ACL repair, then, is suited to a small number of patients, particularly those with proximal ACL tears (meaning tears close to the femoral origin). In one recent case, we were able to offer ACL repair to a patient with an injury pattern consisting of a proximal ACL tear along with an MCL tear and a partial patella tendon tear.
For such patients, ACL repair offers a viable alternative surgery plan with the benefits of their own native ligament and a shorter recovery time.
Advancing research into ACL repair
Modern ACL repair is still a relatively new procedure and its use in clinical practice must continue to be robustly researched to ensure it delivers the promised results.
I am excited to be performing some of the first of these surgeries in WA and to be the first to be undertaking clinical research in this area on the west coast. Along with the research team at POSM Research Institute, I am currently researching ACL repair to see what opportunities this technique holds and what it could add to the treatment options for patients with ACL tears.
As we look to the future, we can perhaps envisage a time when patients may have 3 distinct options for ACL treatment – conservative management, traditional reconstruction or, for a carefully selected cohort, successful ACL repair.
All information is general and is not intended to be a substitute for professional medical advice. Any surgical or invasive procedure carries risks. Dr Ross Radic can consult with you to determine if a particular treatment or procedure is right for you. A second opinion may help you decide on your options.