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II.

I.

Therapeutic study, Level I.

IV.

PurposeIt was the aim to assess all published original research dealing with dynamic repair of the anterior cruciate ligament (ACL) and to provide a semi‐quantitative analysis of clinical outcome reports. MethodsBoth OVIS and MEDLINE databases were utilized for allocation of articles. All preclinical and clinical studies related to dynamic intraligamentary stabilization (DIS) were identified. Results were tabulated and semi‐quantitative analysis performed. ResultsTwenty‐three articles related to DIS were identified. The predominant level of evidence ranged between II and IV, with only one level I study. Reported failure rates ranged between 4% and 13.6%. Most clinical studies only reported revision rates without referring to failure of restoring stability. Highest success was achieved with proximal ACL ruptures. Both the level of physical activity and patient age have been found to influence the risk of failure. ConclusionThere is sufficient evidence to support that DIS repair may be an effective modality for the treatment of acute proximal tears of the ACL. However, comparative studies are lacking. Upcoming studies should compare the technique to ACL reconstruction with failure as an endpoint. Comparison to rigid methods of proximal fixation is also necessary to justify the need for dynamic fixation. Overall, there is evidence to suggest the potential space for ACL repair in the decision tree for individualized treatment planning. The best outcome will be in the hands of the best patient selectors. Level of evidenceIV.

Adjustable loop devices still show biomechanical inferiority and demonstrate heterogeneity of fixation properties with wide- and less-reproducible displacement ranges resultant to the mechanism of adjustment, denoting less reliability. However, three adjustable devices (RIGIDLOOP™ Adjustable, Ultrabutton , ProCinch™) demonstrate fixation capacities within the margins of clinical acceptance. RIGIDLOOP™ Adjustable provides the most comparable fixation properties to fixed loop devices.